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Shi QQ, Yick KL, Wu J, Huang X, Tse CY, Chan MK. A Scientometric Analysis and Visualization of Prosthetic Foot Research Work: 2000 to 2022. Bioengineering (Basel) 2023; 10:1138. [PMID: 37892868 PMCID: PMC10604169 DOI: 10.3390/bioengineering10101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
This study aims to highlight recent research work on topics around prosthetic feet through a scientometric analysis and historical review. The most cited publications from the Clarivate Analytics Web of Science Core Collection database were identified and analyzed from 1 January 2000 to 31 October 2022. Original articles, reviews with full manuscripts, conference proceedings, early access documents, and meeting abstracts were included. A scientometric visualization analysis of the bibliometric information related to the publications, including the countries, institutions, journals, references, and keywords, was conducted. A total of 1827 publications met the search criteria in this study. The related publications grouped by year show an overall trend of increase during the two decades from 2000 to 2022. The United States is ranked first in terms of overall influence in this field (n = 774). The Northwestern University has published the most papers on prosthetic feet (n = 84). Prosthetics and Orthotics International has published the largest number of studies on prosthetic feet (n = 151). During recent years, a number of studies with citation bursts and burst keywords (e.g., diabetes, gait, pain, and sensor) have provided clues on the hotspots of prosthetic feet and prosthetic foot trends. The findings of this study are based on a comprehensive analysis of the literature and highlight the research topics on prosthetic feet that have been primarily explored. The data provide guidance to clinicians and researchers to further studies in this field.
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Affiliation(s)
- Qiu-Qiong Shi
- Laboratory for Artificial Intelligence in Design, Hong Kong, China;
| | - Kit-Lun Yick
- Laboratory for Artificial Intelligence in Design, Hong Kong, China;
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China;
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing 400715, China;
| | - Xujia Huang
- School of Recreational Sports and Tourism, Beijing Sport University, Beijing 100084, China;
| | - Chi-Yung Tse
- Centre for Orthopaedic Surgery, Hong Kong, China;
| | - Mei-Ki Chan
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China;
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Carse B, Hebenton J, Brady L, Davie-Smith F. Absent loading response knee flexion: The impact on gait kinetics and centre of mass motion in individuals with unilateral transfemoral amputation, and the effect of microprocessor controlled knee provision. Clin Biomech (Bristol, Avon) 2023; 108:106061. [PMID: 37556922 DOI: 10.1016/j.clinbiomech.2023.106061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Individuals with unilateral transfemoral amputation walk with increased levels of asymmetry, and this is associated with reduced gait efficiency, back pain and overuse of the intact limb. This study investigated the effect of walking with a unilateral absence of loading response knee flexion on the symmetry of anterior-posterior kinetics and centre of mass accelerations. METHODS A retrospective cohort study design was used, assessing three-dimensional gait data from individuals with unilateral transfemoral amputation (n = 56). The anterior-posterior gait variables analysed included; peak ground reaction forces, impulse, centre of mass acceleration, as well as rate of vertical ground reaction force increase in early stance. With respect to these variables, this study assessed the symmetry between intact and prosthetic limbs, compared intact limbs against a healthy unimpaired control group, and evaluated effect on symmetry of microprocessor controlled knee provision. FINDINGS Significant between-limb asymmetries were found between intact and prosthetic limbs across all variables (p < 0.0001). Intact limbs showed excessive loading when compared with control group limbs after speed normalisation across all variables (p < 0.0001). No improvement in kinetic symmetry following microprocessor controlled knee provision was found. INTERPRETATION The gait asymmetries for individuals with transfemoral amputation identified in this study suggest that more should be done by developers to address the resultant overloading of the intact limb, as this is thought to have negative long-term effects. The provision of microprocessor controlled knees did not appear to improve the asymmetries faced by individuals with transfemoral amputation, and clinicians should be aware of this when managing patient expectations.
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Affiliation(s)
- Bruce Carse
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK.
| | - Joanne Hebenton
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Laura Brady
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Fiona Davie-Smith
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK
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Bartlett HL, Shepherd MK, Lawson BE. A passive dorsiflexing ankle prosthesis to increase minimum foot clearance during swing. WEARABLE TECHNOLOGIES 2023; 4:e15. [PMID: 38487763 PMCID: PMC10936342 DOI: 10.1017/wtc.2023.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 03/17/2024]
Abstract
The biological ankle dorsiflexes several degrees during swing to provide adequate clearance between the foot and ground, but conventional energy storage and return (ESR) prosthetic feet remain in their neutral position, increasing the risk of toe scuffs and tripping. We present a new prosthetic ankle intended to reduce fall risk by dorsiflexing the ankle joint during swing, thereby increasing the minimum clearance between the foot and ground. Unlike previous approaches to providing swing dorsiflexion such as powered ankles or hydraulic systems with dissipative yielding in stance, our ankle device features a spring-loaded linkage that adopts a neutral angle during stance, allowing ESR, but adopts a dorsiflexed angle during swing. The ankle unit was designed, fabricated, and assessed in level ground walking trials on a unilateral transtibial prosthesis user to experimentally validate its stance and swing phase behaviors. The assessment consisted of three conditions: the ankle in an operational configuration, the ankle in a locked configuration (unable to dorsiflex), and the subject's daily use ESR prosthesis. When the ankle was operational, minimum foot clearance (MFC) increased by 13 mm relative to the locked configuration and 15 mm relative to his daily use prosthesis. Stance phase energy return was not significantly impacted in the operational configuration. The increase in MFC provided by the passive dorsiflexing ankle prosthesis may be sufficient to decrease the rate of falls experienced by prosthesis users in the real world.
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Affiliation(s)
| | - Max K. Shepherd
- Department of Mechanical Engineering, Northeastern University, Boston, MA, USA
- Department of Physical Therapy, Northeastern University, Boston, MA, USA
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Manz S, Seifert D, Altenburg B, Schmalz T, Dosen S, Gonzalez-Vargas J. Using embedded prosthesis sensors for clinical gait analyses in people with lower limb amputation: A feasibility study. Clin Biomech (Bristol, Avon) 2023; 106:105988. [PMID: 37230008 DOI: 10.1016/j.clinbiomech.2023.105988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. METHODS Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. FINDINGS The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). INTERPRETATION The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.
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Affiliation(s)
- Sabina Manz
- Ottobock SE & Co. KGaA, Duderstadt, Germany; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | | | | | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Thibaut A, Beaudart C, Maertens DE Noordhout B, Geers S, Kaux JF, Pelzer D. Impact of microprocessor prosthetic knee on mobility and quality of life in patients with lower limb amputation: a systematic review of the literature. Eur J Phys Rehabil Med 2022; 58:452-461. [PMID: 35148043 PMCID: PMC9987462 DOI: 10.23736/s1973-9087.22.07238-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Advanced technologies have made available the development of microprocessor prosthetic knee (MPK) to improve autonomy of patients with lower limb amputation. In the present systematic review, we aimed to evaluate the impact of the use of all types of MPK on patients' functional status and quality of life. EVIDENCE ACQUISITION We conducted this review according to the PRISMA Guidelines on Medline (via Ovid), Scopus and SportDiscuss. All identified articles were screened for their eligibility by two reviewers using Covidence software. The Cochrane Risk of Bias (RoB) or the NIH Quality Assessment Tool were used to assess the quality of the studies. EVIDENCE SYNTHESIS Eighteen articles were included in the present review (7 randomized controlled trials - RCT), 6 cross-sectional and 5 follow-up studies). Number of participants included varied from 20 to 602, protocols' length varied from a single session to 12 weeks of use of MPK. Taken together, MPK users compared to NMPK users tend to present better functional status and mobility. Quality of life was also positively impacted in MPK users. On the other hand, the superiority of more advanced MPKs such as the Genium® is less clear, especially given the improvements over time of other MPKs such as the C-leg® and the Rheo knee®. CONCLUSIONS Based on our results, while it is clear that MPKs outperform NMPKs both for functional status and quality of life, additional benefits of one MPK over another is less clear. Future studies are needed to clarify these aspects.
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Affiliation(s)
- Aurore Thibaut
- CNRF Department of Physical Medicine and Sports Traumatology, University Hospital of Liege, Liege, Belgium.,Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Charlotte Beaudart
- CNRF Department of Physical Medicine and Sports Traumatology, University Hospital of Liege, Liege, Belgium.,World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | | | - Sybille Geers
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Jean-François Kaux
- CNRF Department of Physical Medicine and Sports Traumatology, University Hospital of Liege, Liege, Belgium
| | - Doriane Pelzer
- CNRF Department of Physical Medicine and Sports Traumatology, University Hospital of Liege, Liege, Belgium -
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Ernst M, Altenburg B, Schmalz T, Kannenberg A, Bellmann M. Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes. J Neuroeng Rehabil 2022; 19:9. [PMID: 35090505 PMCID: PMC8796559 DOI: 10.1186/s12984-022-00983-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. METHODS Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. RESULTS Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. CONCLUSIONS The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
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Affiliation(s)
- Michael Ernst
- Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany
| | - Björn Altenburg
- Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany
| | - Thomas Schmalz
- Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany
| | | | - Malte Bellmann
- Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany
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Knight AD, Dearth CL, Hendershot BD. Deleterious Musculoskeletal Conditions Secondary to Lower Limb Loss: Considerations for Prosthesis-Related Factors. Adv Wound Care (New Rochelle) 2021; 10:671-684. [PMID: 32320367 PMCID: PMC8568798 DOI: 10.1089/wound.2019.1079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/23/2020] [Indexed: 11/13/2022] Open
Abstract
Significance: The intent of this work was to summarize the existing evidence of, and highlight knowledge gaps specific to, prosthetic devices/componentry and training regimes, particularly in the context of the human-device interaction and deleterious musculoskeletal conditions secondary to lower limb loss. Recent Advances: With the recent and evolving technological advancements in prostheses, there are numerous devices available to individuals with lower limb loss. Current literature demonstrates the importance of expanding the knowledge of all prosthetic device-specific factors and the significance of proper prescription, fit, and alignment, along with adequate device-/activity-specific training, to enhance human-device interaction, reduce gait abnormalities and compensatory motions, and as a result, mitigate risk for secondary musculoskeletal conditions. Critical Issues: Inadequate device prescription, fit, alignment, and training are evident owing to the lack of knowledge or awareness of the many device-specific properties and factors, leading to suboptimal use, as well as, biomechanical compensations, which collectively and adversely affect the function, activity level, and overall health of the prosthesis user. Future Directions: To maximize optimal outcomes after lower limb loss, it is essential to better appreciate the factors that affect both prosthesis use and satisfaction, particularly any modifiable factors that might be targeted in rehabilitation interventions such as device prescription, fit/alignment, and training regimes. A better understanding of such device-specific factors will help enhance the human-device interaction and resulting functional performance, thereby reducing secondary musculoskeletal conditions, allowing for the readiness of the fighting force (return-to-duty/redeployment) and/or improved reintegration into civilian society/work, and overall enhancing quality of life after lower limb loss.
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Affiliation(s)
- Ashley D. Knight
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher L. Dearth
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brad D. Hendershot
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Ghillebert J, Geeroms J, Flynn L, De Bock S, Govaerts R, Lathouwers E, Crea S, Vitiello N, Lefeber D, Meeusen R, De Pauw K. Performance of the CYBERLEGs motorized lower limb prosthetic device during simulated daily activities. WEARABLE TECHNOLOGIES 2021; 2:e15. [PMID: 38486632 PMCID: PMC10936386 DOI: 10.1017/wtc.2021.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/17/2021] [Accepted: 10/29/2021] [Indexed: 03/17/2024]
Abstract
Background The CYBERLEGs-gamma (CLs-ɣ) prosthesis has been developed to investigate the possibilities of powerful active prosthetics in restoring human gait capabilities after lower limb amputation. Objective The objective of this study was to determine the performance of the CLs-ɣ prosthesis during simulated daily activities. Methods Eight participants with a transfemoral amputation (age: 55 ± 15 years, K-level 3, registered under: NCT03376919) performed a familiarization session, an experimental session with their current prosthesis, three training sessions with the CLs-ɣ prosthesis and another experimental session with the CLs-ɣ prosthesis. Participants completed a stair-climbing-test, a timed-up-and-go-test, a sit-to stand-test, a 2-min dual-task and a 6-min treadmill walk test. Results Comparisons between the two experimental sessions showed that stride length significantly increased during walking with the CLs-ɣ prosthesis (p = .012) due to a greater step length of the amputated leg (p = .035). Although a training period with the prototype was included, preferred walking speed was significantly slower (p = .018), the metabolic cost of transport was significantly higher (p = .028) and reaction times significantly worsened (p = .012) when walking with the CLs-ɣ compared to the current prosthesis. Conclusions It can be stated that a higher physical and cognitive effort were required when wearing the CLs-ɣ prosthesis. Positive outcomes were observed regarding stride length and stair ambulation. Future prosthetics development should minimize the weight of the device and integrate customized control systems. A recommendation for future research is to include several shorter training periods or a prolonged adaptation period.
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Affiliation(s)
- Jo Ghillebert
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Joost Geeroms
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Louis Flynn
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Sander De Bock
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Renée Govaerts
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Elke Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Piazza Martiri della Libertà, Pisa, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Piazza Martiri della Libertà, Pisa, Italy
| | - Dirk Lefeber
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program ‘Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics’, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program ‘Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics’, Vrije Universiteit Brussel, Brussels, Belgium
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Load applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art prosthetic components. Clin Biomech (Bristol, Avon) 2021; 89:105457. [PMID: 34454327 DOI: 10.1016/j.clinbiomech.2021.105457] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study presented the load profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art ÖSSUR microprocessor-controlled Rheo Knee XC and energy-storing-and-returning Pro-Flex XC or LP feet during five standardized daily activities. METHODS This cross-sectional cohort study included 13 participants fitted with a press-fit transfemoral osseointegrated implant. Loading data were directly measured with the tri-axial transducer of an iPecsLab (RTC Electronics, USA) fitted between the implant and knee unit. The loading profile was characterized by spatio-temporal gaits variables, magnitude of loading boundaries as well as onset and magnitude of loading extrema during walking, ascending and descending ramp and stairs. FINDINGS A total of 2127 steps was analysed. The cadence ranged between 36 ± 7 and 47 ± 6 strides/min. The absolute maximum force and moments applied across all activities was 1322 N, 388 N and 133 N as well as 22 Nm, 52 Nm and 88 Nm on and around the long, anteroposterior and mediolateral axes of the implant, respectively. INTERPRETATION This study provided new benchmark loading data applied by transfemoral bone-anchored prostheses fitted with selected ÖSSUR state-of-the-art components. Outcomes suggested that such prostheses can generate relevant loads at the interface with the osseointegrated implant to restore ambulation effectively. This study is a worthwhile contribution toward a systematic recording, analysis, and reporting of ecological prosthetic loading profiles as well as closing the evidence gaps between prescription and biomechanical benefits of state-of-the-art components. Hopefully, this will contribute to improve outcomes for growing number of individuals with limb loss opting for bionic solutions.
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Kowal M, Winiarski S, Gieysztor E, Kołcz A, Walewicz K, Borowicz W, Rutkowska-Kucharska A, Paprocka-Borowicz M. Symmetry function in gait pattern analysis in patients after unilateral transfemoral amputation using a mechanical or microprocessor prosthetic knee. J Neuroeng Rehabil 2021; 18:9. [PMID: 33468184 PMCID: PMC7816420 DOI: 10.1186/s12984-021-00810-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Above-knee amputations (AKAs) contribute to gait asymmetry. The level of asymmetry is affected by the type of knee prosthetic module. There is limited evidence suggesting that more technically advanced solutions (microprocessor modules; MicPK) are superior to less advanced ones (mechanical modules; MechPK). The study aimed to evaluate the variable range of hip and pelvic joint movements during gait and look for differentiating areas with an increased level of asymmetry of the gait cycle in individuals who underwent an AKA and are equipped with MicPK or MechPK. METHODS Twenty-eight individuals participated in the study; 14 were assigned to a study group of individuals who underwent a unilateral AKA, and the other 14 were healthy participants as a control group. The movement task was recorded using the optoelectronic SMART-E system following the standard Davis protocol (the Newington model). A new method of quantifying gait symmetry using the symmetry function (SF) is proposed. SF is an integral measure of absolute differences in time-standardized signals between sides throughout the whole cycle of motion variability. RESULTS In the frontal plane, there were significant differences between groups in the asymmetry of the range of movement in the hip joint of the intact limb. In the middle of the support phase, the intact limb was more adducted in individuals with MicPK and less abducted in people with MechPK (differences in mean 180%, p < 0.000; max 63%, p < 0.000; min 65%, p < 0.000). In the sagittal plane, the range of asymmetry of the flexion and thigh extension of the intact limb was similar to and only slightly different from the physiological gait. In the transverse plane, higher asymmetry values were noted for individuals with MicPK. In the final stage of the swing phase, the thigh was more rotated both externally and internally. The size of the asymmetry, when compared to gait of healthy individuals, reached 50% (differences in mean 115%, p < 0.232; max 62% p < 0.26; min 50, p < 0.154). CONCLUSIONS In the study group, the assessed ranges of pelvic and thigh movement in the hip joint differed only in the frontal plane. Individuals who underwent a unilateral above-knee amputation may gain less from using MicPK than anticipated.
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Affiliation(s)
- Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
| | - Sławomir Winiarski
- Department of Biomechanics, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Ewa Gieysztor
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
| | - Anna Kołcz
- Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
- Laboratory of Ergonomics and Biomedical Monitoring, Wroclaw Medical University, Wroclaw, Poland
| | | | - Wojciech Borowicz
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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Hobusch GM, Döring K, Brånemark R, Windhager R. Advanced techniques in amputation surgery and prosthetic technology in the lower extremity. EFORT Open Rev 2020; 5:724-741. [PMID: 33204516 PMCID: PMC7608512 DOI: 10.1302/2058-5241.5.190070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates.Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons.Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines.Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints.As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price.Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way.Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070.
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Affiliation(s)
- Gerhard M Hobusch
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Kevin Döring
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Rickard Brånemark
- Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Reinhard Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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12
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Andrysek J, García D, Rozbaczylo C, Alvarez-Mitchell C, Valdebenito R, Rotter K, Wright FV. Biomechanical responses of young adults with unilateral transfemoral amputation using two types of mechanical stance control prosthetic knee joints. Prosthet Orthot Int 2020; 44:314-322. [PMID: 32389076 DOI: 10.1177/0309364620916385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prosthetic knee joint function is important in the rehabilitation of individuals with transfemoral amputation. OBJECTIVES The objective of this study was to assess the gait patterns associated with two types of mechanical stance control prosthetic knee joints-weight-activated braking knee and automatic stance-phase lock knee. It was hypothesized that biomechanical differences exist between the two knee types, including a prolonged swing-phase duration and exaggerated pelvic movements for the weight-activated braking knee during gait. STUDY DESIGN Prospective crossover study. METHODS Spatiotemporal, kinematic, and kinetic parameters were obtained via instrumented gait analysis for 10 young adults with a unilateral transfemoral amputation. Discrete gait parameters were extracted based on their magnitudes and timing. RESULTS A 1.01% ± 1.14% longer swing-phase was found for the weight-activated braking knee (p < 0.05). The prosthetic ankle push-off also occurred earlier in the gait cycle for the weight-activated braking knee. Anterior pelvic tilt was 3.3 ± 3.0 degrees greater for the weight-activated braking knee. This range of motion was also higher (p < 0.05) and associated with greater hip flexion angles. CONCLUSIONS Stance control affects biomechanics primarily in the early and late stance associated with prosthetic limb loading and unloading. The prolonged swing-phase time for the weight-activated braking knee may be associated with the need for knee unloading to initiate knee flexion during gait. The differences in pelvic tilt may be related to knee stability and possibly the different knee joint stance control mechanisms. CLINICAL RELEVANCE Understanding the influence of knee function on gait biomechanics is important in selecting and improving treatments and outcomes for individuals with lower-limb amputations. Weight-activated knee joints may result in undesired gait deviations associated with stability in early stance-phase, and swing-phase initiation in the late stance-phase of gait.
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Affiliation(s)
- Jan Andrysek
- Holland Bloorview Kids Rehabilitation Hospital and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | - F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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13
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Şen Eİ, Aydın T, Buğdaycı D, Kesiktaş FN. Effects of microprocessor-controlled prosthetic knees on self-reported mobility, quality of life, and psychological states in patients with transfemoral amputations. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:502-506. [PMID: 33155559 DOI: 10.5152/j.aott.2020.19269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the effects of the microprocessor-controlled prosthetic knee (MPK) joint on self-mobility, body perceptions, depression, and quality of life in patients with unilateral transfemoral amputations (TFAs). METHODS Thirty consecutive patients (28 males, mean age=38.5 years, age range=22-57) who had previously used non-MPKs and who were approved to use swing and stance phase-control MPKs were included in this 12-week clinical study. Before the MPK use and after the three-month follow-up, prosthetic use and locomotor capabilities were evaluated using the Houghton Scale and the Locomotor Capabilities Index (LCI-5), respectively. Body perception was assessed using the Amputee Body Image Scale (ABIS). The depressive symptoms and quality of life were evaluated using the Beck Depression Inventory (BDI) score and the 36-Item Short- Form Health Survey (SF-36), respectively. RESULTS After MPK use, statistically significant ameliorations were observed in all outcome measures. The basic and advanced LCI-5 increased from 26.7±2.2 and 24.8±5.2 to 27.6±1.2 (p=0.007) and 27±2.1 (p=0.004), respectively. Houghton scores improved from 9±1 to 10.3±0.8 (p=0.000). The ABIS and BDI scores decreased from 43.2±10.9 and 5.7±6.6 to 37.1±8.9 (p=0.000) and 3.8±4.5 (p=0.015), respectively. Also, the SF-36 physical function and vitality subscales increased from 71.2±24.0 and 75.5±14.6 to 85.6±16.6 (p=0.001) and 81.7±14.1 (p=0.015), respectively. CONCLUSION MPK use provides significant improvements in the locomotor capabilities, quality of life, and activities of daily living to patients with TFAs as well as improves their body image perceptions and depressive symptoms. LEVEL OF EVIDENCE Level III, Self controlled study.
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Affiliation(s)
- Ekin İlke Şen
- Department of Physical Medicine and Rehabilitation, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Tuğba Aydın
- Department of Physical Medicine and Rehabilitation İstanbul Physical Medicine and Rehabilitation Training and Research Hospital, İstanbul, Turkey
| | - Derya Buğdaycı
- Department of Physical Medicine and Rehabilitation İstanbul Physical Medicine and Rehabilitation Training and Research Hospital, İstanbul, Turkey
| | - Fatma Nur Kesiktaş
- Department of Physical Medicine and Rehabilitation İstanbul Physical Medicine and Rehabilitation Training and Research Hospital, İstanbul, Turkey
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14
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Castiglia SF, Ranavolo A, Varrecchia T, De Marchis C, Tatarelli A, Magnifica F, Fiori L, Conte C, Draicchio F, Conforto S, Serrao M. Pelvic obliquity as a compensatory mechanism leading to lower energy recovery: Characterization among the types of prostheses in subjects with transfemoral amputation. Gait Posture 2020; 80:280-284. [PMID: 32563728 DOI: 10.1016/j.gaitpost.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking. RESEARCH QUESTION This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis. METHODS The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis. RESULTS Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls. SIGNIFICANCE Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Fabrizio Magnifica
- Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy; Italian Air Force Aerospace Medicine Department, Diagnostic Therapeutic and Rehabilitative Aeromedical Center, via Piero Gobetti 2, 00185, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Carmela Conte
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi, 6, 20121, Milan, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy; Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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15
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Tatarelli A, Serrao M, Varrecchia T, Fiori L, Draicchio F, Silvetti A, Conforto S, De Marchis C, Ranavolo A. Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation. SENSORS 2020; 20:s20092543. [PMID: 32365715 PMCID: PMC7249183 DOI: 10.3390/s20092543] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022]
Abstract
The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device.
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Affiliation(s)
- Antonella Tatarelli
- Department of Human Neurosciences, University of Rome Sapienza, 00185 Rome, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
- Correspondence:
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, 04100 Latina, Italy;
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Lorenzo Fiori
- Department of Physiology and Pharmacology, University of Rome Sapienza, 00185 Rome, Italy;
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Alessio Silvetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, 00185 Rome, Italy; (S.C.); (C.D.M.)
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, 00185 Rome, Italy; (S.C.); (C.D.M.)
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
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16
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Mileusnic MP, Rettinger L, Highsmith MJ, Hahn A. Benefits of the Genium microprocessor controlled prosthetic knee on ambulation, mobility, activities of daily living and quality of life: a systematic literature review. Disabil Rehabil Assist Technol 2019; 16:453-464. [DOI: 10.1080/17483107.2019.1648570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - M. Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences. Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Andreas Hahn
- Otto Bock Healthcare Products GmbH, Vienna, Austria
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17
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Okita Y, Yamasaki N, Nakamura T, Mita T, Kubo T, Mitsumoto A, Akune T. Intra-individual biomechanical effects of a non-microprocessor-controlled stance-yielding prosthetic knee during ramp descent in persons with unilateral transfemoral amputation. Prosthet Orthot Int 2019; 43:55-61. [PMID: 30051754 DOI: 10.1177/0309364618789453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: A stance-yielding mechanism for prosthetic knees may reduce lower limb loading during specific activities, but quantitative data are insufficient. OBJECTIVES: To clarify the biomechanical effect of a non-microprocessor-controlled stance-yielding mechanism on ramp descent for individuals with unilateral transfemoral amputation. STUDY DESIGN: Intra-subject intervention study. METHODS: Seven individuals with unilateral transfemoral amputation underwent three-dimensional motion analysis of ramp descent with and without activating a stance-yielding mechanism. Regarding early-stance internal joint moment and ground reaction force, whole-group and subgroup analyses stratified by stance prosthetic knee flexion were performed to verify differences in prosthetic side and contralateral limb loading between conditions. RESULTS: Whole-group analysis revealed significant reduction in early-stance prosthetic knee extension moment with stance-yielding mechanism activation. Changes in prosthetic side hip extension moment and contralateral limb loading were inconsistent between conditions. Subjects with prosthetic stance knee flexion walked slower with a smaller stride and greater increase in aft ground reaction force and ankle dorsiflexion moment when stance-yielding was activated. CONCLUSION: Stance-yielding mechanism has a biomechanical potential to decrease excessive knee hyperextension. However, prosthetic side stance knee flexion induced by the stance-yielding mechanism might not necessarily reduce the mechanical load on residual hip or contralateral lower limb joints. CLINICAL RELEVANCE This study showed individual variability in the possibility of reducing the load on the remaining lower limb when using a non-microprocessor-controlled stance-yielding knee. This suggests that individualized prosthetic management and monitoring the activities of individuals wearing a stance-yielding prosthetic knee are crucial to maximize the benefits of stance-yielding prosthetic knees.
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Affiliation(s)
- Yusuke Okita
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Nobuya Yamasaki
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Takashi Nakamura
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Tomoki Mita
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Tsutomu Kubo
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Atsuko Mitsumoto
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
| | - Toru Akune
- 1 Department of Prosthetics and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
- 2 Hospital, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan
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18
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Arnold S, Mackenzie L, Millington M, James C. Occupational therapy medicolegal assessment of domestic assistance requirements: Focus group perspectives. Aust Occup Ther J 2018; 66:239-248. [PMID: 30565233 DOI: 10.1111/1440-1630.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Estimating domestic assistance requirements within the medicolegal field is a role for occupational therapists. It is a complex multidimensional process of clinical reasoning with no published research outlining how an occupational therapist translates assessment data into the number of hours of domestic assistance required. This study describes the current occupational therapy practice of estimating domestic assistance hours within the medicolegal context. METHOD Three focus groups, totalling 14 occupational therapists providing medicolegal reports in New South Wales, were conducted. Sydney University provided ethics approval. Focus group data were thematically analysed. RESULTS Four themes were identified: Tasks included as housework. Assessment process - interview of pre-injury and recovery status; functional performance on specific tasks and a tour of the home. Influential factors - include legal system restrictions, medical management, cultural and society values, family expectations, location and impact of diagnosis. Strategies to determine care - triangulation of observed data with medical reports and clinical experience. Knowledge of community and own performance times within the framework of occupational therapy philosophy DISCUSSION: No single method of translating assessment data to hours of care was identified. Therapists use of their own housework performance raises ethical issues. Use of claimant only statements raises issues of inaccurate data on which to base decisions. Therapists should refer to occupational therapy process of clinical reasoning to explain their recommendations even though the reasoning does not give a definite number of care hours. CONCLUSION Therapists need to understand the factors influencing their clinical reasoning when integrating all available information into an estimating of domestic assistance hours. Further study analysing the content of medicolegal report may provide information as to how therapists document their clinical reasoning for court.
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Affiliation(s)
- Susan Arnold
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Michael Millington
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Carole James
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
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Abdulhasan ZM, Scally AJ, Buckley JG. Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system. Clin Biomech (Bristol, Avon) 2018; 57:35-41. [PMID: 29908391 DOI: 10.1016/j.clinbiomech.2018.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. METHODS Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its 'ramp-descent' mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. FINDINGS Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). INTERPRETATION Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity.
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Affiliation(s)
- Zahraa M Abdulhasan
- Division of Biomedical Engineering, School of Engineering, University of Bradford, BD7 1DP, UK
| | - Andy J Scally
- School of Health Studies, University of Bradford, BD7 1DP, UK
| | - John G Buckley
- Division of Biomedical Engineering, School of Engineering, University of Bradford, BD7 1DP, UK.
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20
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Okita Y, Yamasaki N, Nakamura T, Kubo T, Mitsumoto A, Akune T. Kinetic differences between level walking and ramp descent in individuals with unilateral transfemoral amputation using a prosthetic knee without a stance control mechanism. Gait Posture 2018; 63:80-85. [PMID: 29723652 DOI: 10.1016/j.gaitpost.2018.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/22/2018] [Accepted: 04/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with transfemoral amputation (TFA) have difficulty in descending ramps. Although individuals with TFA who descend ramps are speculated to have greater biomechanical demands, this has not been quantified. RESEARCH QUESTION How do individuals with TFA wearing a prosthetic knee without a stance control mechanism adapt their gait biomechanics to a slightly declined surface? METHODS We retrospectively analyzed data of level walking and ramp descent (5° decline) from six subjects with TFA who used a prosthesis without a stance control mechanism. Ground reaction force and joint moment, power, and kinematics were derived from three-dimensional motion capture, combined with force measurement. Kinematic and kinetic variables were compared during level walking and ramp descent using the paired tests. RESULTS Compared with level walking, ramp descent increased the maximum contralateral vertical ground reaction force by 16% of the body weight, on average (standard deviation: 20%). Ramp descent tended to induce smaller concentric hip power during late swing and greater hip eccentric power on the prosthetic-side during late stance. Greater biomechanical demands during ramp descent were indicated by increased maximum medial ground reaction force on both sides, and eccentric joint power of the contralateral ankle during stance. SIGNIFICANCE For individuals with TFA using a prosthetic knee without a stance control mechanism, descending a ramp can increase loading on the contralateral limb during the loading response; slower walking may alleviate the effect. Ramp descent can change prosthetic-side hip muscles' control of the swinging prosthetic limb, eccentric work on the contralateral ankle plantarflexors during stance, and mediolateral balance. All of these factors should be taken into consideration when individuals with TFA learn to descend a ramp.
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Affiliation(s)
- Yusuke Okita
- Department of Prosthetic and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan.
| | - Nobuya Yamasaki
- Department of Prosthetic and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan
| | - Takashi Nakamura
- Department of Prosthetic and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan
| | - Tsutomu Kubo
- Department of Prosthetic and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan
| | - Atsuko Mitsumoto
- Department of Prosthetic and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan
| | - Toru Akune
- Department of Prosthetic and Orthotics, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan; Hospital, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-Shi, Saitama 359-8555, Japan
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21
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Morgenroth DC, Roland M, Pruziner AL, Czerniecki JM. Transfemoral amputee intact limb loading and compensatory gait mechanics during down slope ambulation and the effect of prosthetic knee mechanisms. Clin Biomech (Bristol, Avon) 2018; 55:65-72. [PMID: 29698851 DOI: 10.1016/j.clinbiomech.2018.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/28/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intact limb knee osteoarthritis is a prevalent secondary disability in transfemoral amputees. Walking down a ramp may increase this risk due to excessive limb loading. We sought to determine whether intact limb loading differed between transfemoral amputees and controls during down slope ambulation, and the compensatory strategies transfemoral amputees used to modify intact limb loading. Secondarily, we sought to determine the effect of prosthetic knee type. METHODS Five unilateral transfemoral amputees and five non-amputee controls walked down a ramp and the following outcome measures were compared between amputees and controls and across prosthetic knee type (C-leg versus Power Knee): step length, walking speed, leading limb ground reaction forces, and trailing and leading limb ankle and knee energy absorption. Linear mixed effects regression was used to test for association between gait variables and limb. FINDINGS There were no significant differences in intact limb loading between amputees and controls or between prosthetic knee types. Transfemoral amputees walked slower (C-leg - control = -0.29 m/s; P = 0.008, Power Knee - control = -0.38 m/s; P < 0.001) with a shorter intact limb step length (C-leg - control = -0.12 m/s; P < 0.001, Power Knee - control = -0.16 m/s; P < 0.001). The prosthetic trailing limb ankle absorbed less energy throughout stance than the trailing limb in controls (C-leg-control = -0.22 J/kg; P < 0.001, Power Knee - control = -0.22 J/kg; P < 0.001). INTERPRETATION Intact limb loading in transfemoral amputees is equivalent to controls during down ramp ambulation, in spite of reduced prosthetic trailing limb energy absorption. The primary compensatory strategies include a reduced ambulation speed and intact limb step length, which reduces center of mass velocity at heel contact.
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Affiliation(s)
- David C Morgenroth
- VA Rehabilitation Research and Development Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | - Michelle Roland
- VA Rehabilitation Research and Development Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Alison L Pruziner
- DoD/VA Extremity Trauma and Amputation Center of Excellence, USA; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph M Czerniecki
- VA Rehabilitation Research and Development Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Ülger Ö, Yıldırım Şahan T, Çelik SE. A systematic literature review of physiotherapy and rehabilitation approaches to lower-limb amputation. Physiother Theory Pract 2018; 34:821-834. [PMID: 29351504 DOI: 10.1080/09593985.2018.1425938] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Successful use of prostheses after lower-limb amputation (LLA) depends on undergoing physiotherapy and rehabilitation both physically and psychologically. The aim of this systematic literature review is to systematically review the scientific evidence regarding prosthetic rehabilitation and physiotherapy after LLA. METHODS A systematic literature search was conducted using PubMed, Web of Science, Cochrane, CINAHL, EMBASE, SCOPUS, and EMB Reviews databases on December 31, 2015. Studies with the search keywords were identified and independently assessed by reviewers. The search yielded 403 potentially relevant articles after the removal of duplicates. Of these, only nine articles met the inclusion criteria. All studies were original articles, one of which was a randomized controlled study. Different measurement methods were used and positive results in terms of functional status, weight-lifting capacity with prosthesis, walking and balance ability, and acute care process were gained with a physiotherapy program. Conventional methods still possess high importance; however, it is safe to say that virtual reality and software-based programs for rehabilitation are increasingly being developed and getting more and more support. DISCUSSION LLA rehabilitation is a topic that requires the focus of current and future studies; evidence-based studies are required on the approaches to rehabilitation for specific LLA groups.
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Affiliation(s)
- Özlem Ülger
- a Health Sciences Faculty, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Tezel Yıldırım Şahan
- b Health Sciences Faculty, Department of Physiotherapy and Rehabilitation , Kırıkkale University , Kırıkkale , Turkey
| | - Seher Erol Çelik
- c Health Sciences Faculty, Department of Physiotherapy and Rehabilitation , İnönü University , Malatya
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23
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Wanamaker AB, Andridge RR, Chaudhari AM. When to biomechanically examine a lower-limb amputee: A systematic review of accommodation times. Prosthet Orthot Int 2017; 41:431-445. [PMID: 28946826 DOI: 10.1177/0309364616682385] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hundreds of investigations examining biomechanical outcomes of various prostheses have been completed, but one question remains unanswered: how much time should an amputee be given to accommodate to a new prosthesis prior to biomechanical testing? OBJECTIVE To examine the literature for accommodation time given during biomechanical investigations to determine whether consensus exists. STUDY DESIGN Systematic review. METHODS A systematic search was completed on 7 January 2016 using PubMed and Scopus. RESULTS The search resulted in 156 investigations. Twenty-eight studies did not provide an accommodation or were unclear (e.g. provided a "break in period"), 5 studies tested their participants more than once, 25 tested only once and on the same day participants received a new prosthesis (median (range): above-knee: 60 (10-300) min; below-knee: 18 (5-300) min), and 98 tested once and gave a minimum of 1 day for accommodation (hip: 77 (60-180) days; above-knee: 42 (1-540) days; below-knee: 21 (1-475) days). CONCLUSION The lack of research specifically examining accommodation and the high variability in this review's results indicates that it remains undecided how much accommodation is necessary. There is a need for longitudinal biomechanical investigations to determine how outcomes change as amputees accommodate to a new prosthesis. Clinical relevance The results of this review indicate that little research has been done regarding lower-limb amputees accommodating to a new prosthesis. Improper accommodation could lead to increased variability in results, results that are not reflective of long-term use, and could cause clinicians to make inappropriate decisions regarding a prosthesis.
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Highsmith MJ, Klenow TD, Kahle JT, Wernke MM, Carey SL, Miro RM, Lura DJ. EFFECTS OF THE GENIUM MICROPROCESSOR KNEE SYSTEM ON KNEE MOMENT SYMMETRY DURING HILL WALKING. TECHNOLOGY AND INNOVATION 2017; 18:151-157. [PMID: 28066523 DOI: 10.21300/18.2-3.2016.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Use of the Genium microprocessor knee (MPK) system reportedly improves knee kinematics during walking and other functional tasks compared to other MPK systems. This improved kinematic pattern was observed when walking on different hill conditions and at different speeds. Given the improved kinematics associated with hill walking while using the Genium, a similar improvement in the symmetry of knee kinetics is also feasible. The purpose of this study was to determine if Genium MPK use would reduce the degree of asymmetry (DoA) of peak stance knee flexion moment compared to the C-Leg MPK in transfemoral amputation (TFA) patients. This study used a randomized experimental crossover of TFA patients using Genium and C-Leg MPKs (n = 20). Biomechanical gait analysis by 3D motion tracking with floor mounted force plates of TFA patients ambulating at different speeds on 5° ramps was completed. Knee moment DoA was significantly different between MPK conditions in the slow and fast uphill as well as the slow and self-selected downhill conditions. In a sample of high-functioning TFA patients, Genium knee system accommodation and use improved knee moment symmetry in slow speed walking up and down a five degree ramp compared with C-Leg. Additionally, the Genium improved knee moment symmetry when walking downhill at comfortable speed. These results likely have application in other patients who could benefit from more consistent knee function, such as older patients and others who have slower walking speeds.
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Affiliation(s)
- M Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA
| | - Tyler D Klenow
- Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Jason T Kahle
- OP Solutions, Inc., Tampa, FL, USA; Prosthetic Design and Research, Tampa, FL, USA
| | | | - Stephanie L Carey
- Department of Mechanical Engineering, University of South Florida, Tampa, FL, USA
| | - Rebecca M Miro
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Derek J Lura
- Department of Bioengineering and Software Engineering, Florida Gulf Coast University, Ft. Myers, FL, USA
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Dhokia V, Bilzon J, Seminati E, Talamas DC, Young M, Mitchell W. The Design and Manufacture of a Prototype Personalized Liner for Lower Limb Amputees. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.procir.2017.02.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation. Phys Ther 2016; 96:1896-1904. [PMID: 27277497 PMCID: PMC5131184 DOI: 10.2522/ptj.20150566] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/30/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Roughly 50% of individuals with lower limb amputation report a fear of falling and fall at least once a year. Perturbation-based gait training and the use of virtual environments have been shown independently to be effective at improving walking stability in patient populations. An intervention was developed combining the strengths of the 2 paradigms utilizing continuous, walking surface angle oscillations within a virtual environment. This case report describes walking function and mediolateral stability outcomes of an individual with a unilateral transfemoral amputation following a novel perturbation-based gait training intervention in a virtual environment. CASE DESCRIPTION The patient was a 43-year-old male veteran who underwent a right transfemoral amputation 7+ years previously as a result of a traumatic blast injury. He used a microprocessor-controlled knee and an energy storage and return foot. OUTCOMES Following the intervention, multiple measures indicated improved function and stability, including faster self-selected walking speed and reduced functional stepping time, mean step width, and step width variability. These changes were seen during normal level walking and mediolateral visual field or platform perturbations. In addition, benefits were retained at least 5 weeks after the final training session. DISCUSSION The perturbation-based gait training program in the virtual environment resulted in the patient's improved walking function and mediolateral stability. Although the patient had completed intensive rehabilitation following injury and was fully independent, the intervention still induced notable improvements to mediolateral stability. Thus, perturbation-based gait training in challenging simulated environments shows promise for improving walking stability and may be beneficial when integrated into a rehabilitation program.
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27
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Hahn A, Lang M, Stuckart C. Analysis of clinically important factors on the performance of advanced hydraulic, microprocessor-controlled exo-prosthetic knee joints based on 899 trial fittings. Medicine (Baltimore) 2016; 95:e5386. [PMID: 27828871 PMCID: PMC5106077 DOI: 10.1097/md.0000000000005386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/12/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
The objective of this work is to evaluate whether clinically important factors may predict an individual's capability to utilize the functional benefits provided by an advanced hydraulic, microprocessor-controlled exo-prosthetic knee component.This retrospective cross-sectional cohort analysis investigated the data of above knee amputees captured during routine trial fittings. Prosthetists rated the performance indicators showing the functional benefits of the advanced maneuvering capabilities of the device. Subjects were asked to rate their perception. Simple and multiple linear and logistic regression was applied.Data from 899 subjects with demographics typical for the population were evaluated. Ability to vary gait speed, perform toileting, and ascend stairs were identified as the most sensitive performance predictors. Prior C-Leg users showed benefits during advanced maneuvering. Variables showed plausible and meaningful effects, however, could not claim predictive power. Mobility grade showed the largest effect but also failed to be predictive.Clinical parameters such as etiology, age, mobility grade, and others analyzed here do not suffice to predict individual potential. Daily walking distance may pose a threshold value and be part of a predictive instrument. Decisions based solely on single parameters such as mobility grade rating or walking distance seem to be questionable.
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Affiliation(s)
- Andreas Hahn
- Otto Bock Healthcare Products GmbH, Vienna, Austria
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28
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Highsmith MJ, Kahle JT, Wernke MM, Carey SL, Miro RM, Lura DJ, Sutton BS. EFFECTS OF THE GENIUM KNEE SYSTEM ON FUNCTIONAL LEVEL, STAIR AMBULATION, PERCEPTIVE AND ECONOMIC OUTCOMES IN TRANSFEMORAL AMPUTEES. TECHNOLOGY AND INNOVATION 2016; 18:139-150. [PMID: 27917268 PMCID: PMC5134931 DOI: 10.21300/18.2-3.2016.139] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Compared to non-microprocessor knees, the C-Leg microprocessor knee (MPK) is bioenergentically and economically more efficient and safer for transfemoral amputation (TFA) patients. The Genium MPK has demonstrated improvements in perceived function, knee kinematics, and physical functional performance compared to C-Leg. Clinical and health economic analyses have not been conducted with the Genium knee system. The purpose of this study was to determine if laboratory determined benefits of Genium are detectable using common clinical assessments and if there are economic benefits associated with its use. This study utilized a randomized AB crossover study with 60 d follow-up including cost-effectiveness analysis. Twenty TFA patients tested with both knees in mobility and preference measures. Incremental cost-effectiveness ratios (ICER) were calculated based on performance measures. Stair Assessment Index scores improved with Genium. Mean stair completion times and descent stepping rate were not different between knees. Stair ascent stepping rate for C-Leg was greater compared with Genium (p = 0.04). Genium use decreased Four square step test completion time and increased functional level and step activity (p ≤ 0.05). Further, Genium use improved (p ≤ 0.05) function and safety in three out of five Activities of Daily Living (ADL) survey domains. Finally, more subjects preferred Genium following testing. Functional measures were used to calculate ICERs. ICER values for Genium fall within established likely-to-accept value ranges. Compared with C-Leg, Genium use improved stair walking performance, multi-directional stepping, functional level, and perceived function. In this group of community ambulators with TFA, Genium was preferred, and, while more costly, it may be worth funding due to significant improvements in functional performance with ADLs.
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Affiliation(s)
- M. Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
- Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA
- 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA
| | - Jason T. Kahle
- OP Solutions, Inc., Tampa, FL, USA
- Prosthetic Design + Research, Tampa, FL, USA
| | | | - Stephanie L. Carey
- Department of Mechanical Engineering, University of South Florida, Tampa, FL, USA
| | - Rebecca M. Miro
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Derek J. Lura
- Department of Bioengineering and Software Engineering, Florida Gulf Coast University, Ft. Myers, FL, USA
| | - Bryce S. Sutton
- Center of Innovation on Disability and Rehabilitation Research (CINDRR-TPA), James A. Haley Veterans’ Hospital, Tampa, FL, USA
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29
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Highsmith MJ, Andrews CR, Millman C, Fuller A, Kahle JT, Klenow TD, Lewis KL, Bradley RC, Orriola JJ. Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review. TECHNOLOGY AND INNOVATION 2016; 18:99-113. [PMID: 28066520 DOI: 10.21300/18.2-3.2016.99] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked.
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Affiliation(s)
- M Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA
| | - Casey R Andrews
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Claire Millman
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Ashley Fuller
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Jason T Kahle
- OP Solutions, Tampa, FL, USA; Prosthetic Design + Research, Tampa, FL, USA
| | - Tyler D Klenow
- Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Katherine L Lewis
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Rachel C Bradley
- Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - John J Orriola
- Shimberg Health Sciences Library, University of South Florida, Tampa, FL, USA
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Bell EM, Pruziner AL, Wilken JM, Wolf EJ. Performance of conventional and X2® prosthetic knees during slope descent. Clin Biomech (Bristol, Avon) 2016; 33:26-31. [PMID: 26921583 DOI: 10.1016/j.clinbiomech.2016.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 12/24/2015] [Accepted: 01/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with transfemoral amputation often have difficulty descending sloped surfaces due to increased lower extremity range of motion and torque requirements. The X2®, a new microprocessor-controlled prosthetic knee, claims to improve gait over sloped terrain. The aim of this study was to evaluate how experienced prosthesis users descended a sloped surface using the X2®, compared to a conventional knee, either mechanical (MECH) or microprocessor (MP). METHODS Descent technique and biomechanics were assessed in 21 service members with unilateral transfemoral amputation as they descended an instrumented 10° slope at a self-selected walking velocity. FINDINGS Use of the X2® in the MECH group resulted in greater hill assessment scores (8.5 to 11.0, P=0.026), due primarily to decreased reliance on handrail use. The use of the X2® in the MP group increased prosthetic knee flexion to a median of 6.4° at initial contact (P=0.002) and 73.7° in swing (P=0.005), contributing to longer prosthetic limb steps (P=0.024) and increased self-selected velocity (P=0.041). Additionally, the use of the X2® in the MP group increased prosthetic limb impact peaks (11.6N/kg, P=0.004), improving impact peak symmetry to -1.3% (P=0.004). INTERPRETATION Decreased reliance on handrail use as MECH users descended in the X2® indicate improved function and perhaps greater confidence in the device. Additional biomechanical improvements for existing MP users suggest potential longer-term benefits with regard to intact limb health and overuse injuries.
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Affiliation(s)
- Elizabeth M Bell
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; DOD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA
| | - Alison L Pruziner
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; DOD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA
| | - Jason M Wilken
- Center for the Intrepid, San Antonio Military Medical Center, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Erik J Wolf
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; DOD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA.
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Schalk SAF, Jonkergouw N, van der Meer F, Swaan WM, Aschoff HH, van der Wurff P. The Evaluation of Daily Life Activities after Application of an Osseointegrated Prosthesis Fixation in a Bilateral Transfemoral Amputee: A Case Study. Medicine (Baltimore) 2015; 94:e1416. [PMID: 26356693 PMCID: PMC4616661 DOI: 10.1097/md.0000000000001416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Individuals with a transfemoral amputation (TFA) may experience limitations in daily life due to reduced mobility and prosthesis-related problems. An osseointegrated prosthesis fixation (OPF) procedure in amputees might contribute to a solution for patients with short stumps or socket-related problems. To date, no study has specifically described the application of an OPF procedure in individuals with a TFA. This study evaluated the level of daily life activities of a 21-year old service member with a bilateral TFA and cerebral trauma. Due to a short stump length and coordination problems, an OPF procedure was deemed the most suitable option.The result of this procedure and the rehabilitation program showed an increased mobility and satisfaction as obtained by the assessment of life habits questionnaire (LIFE-H) and lower extremity functional scale. The participant was able to walk short distances and the Genium knee provided a stance position. Stair ambulation is impossible because of inadequate muscle capacity.In this specific case we conclude that the quality of life improved through the use of an OPF. However, OPF might not be the appropriate device for every individual with TFA, due to varying bone compositions, co-morbidities, and limited clinical experience and unknown long-term effects.
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Affiliation(s)
- Stephanie A F Schalk
- From the Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands (SAFS, NJ, FVDM, WMS, HHA, PVDW); Sana Krankenhaus Süd Klinik für Plastische, Hand- und Rekonstruktive Chirurgie Kronsforder Allee 71-73, 23560 Lübeck, Schleswig-Holstein, Germany (HHA); and Department of Physical Therapy, HU University of Applied Sciences Utrecht, Bolognalaan 101, 3584 CJ, Utrecht, The Netherlands (PVDW)
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