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Bruening DA, Petersen SR, Ridge ST. New Perspectives on Foot Segment Forces and Joint Kinetics-Integrating Plantar Shear Stresses and Pressures with Multi-segment Foot Modeling. Ann Biomed Eng 2024; 52:1719-1731. [PMID: 38494465 DOI: 10.1007/s10439-024-03484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/24/2024] [Indexed: 03/19/2024]
Abstract
The role of the many small foot articulations and plantar tissues in gait is not well understood. While kinematic multi-segment foot models have increased our knowledge of foot segmental motions, the integration of kinetics with these models could further advance our understanding of foot mechanics and energetics. However, capturing and effectively utilizing segmental ground reaction forces remains challenging. The purposes of this study were to (1) develop methodology to integrate plantar pressures and shear stresses with a multi-segment foot model, and (2) generate and concisely display key normative data from this combined system. Twenty-six young healthy adults walked barefoot (1.3 m/s) across a pressure/shear sensor with markers matching a published 4-segment foot model. A novel anatomical/geometric template-based masking method was developed that successfully separated regions aligned with model segmentation. Directional shear force plots were created to summarize complex plantar shear distributions, showing opposing shear forces both between and within segments. Segment centers of pressure (CoPs) were shown to be primarily stationary within each segment, suggesting that forward progression in healthy gait arises primarily from redistributing weight across relatively fixed contact points as opposed to CoP movement within a segment. Inverse dynamics-based normative foot joint moments and power were presented in the context of these CoPs to aid in interpretation of tissue stresses. Overall, this work represents a successful integration of motion capture with direct plantar pressure and shear measurements for multi-segment foot kinetics. The presented tools are versatile enough to be used with other models and contexts, while the presented normative database may be useful as a baseline comparison for clinical work in gait energetics and efficiency, balance, and motor control. We hope that this work will aid in the advancement and availability of kinetic MSF modeling, increase our knowledge of foot mechanics, and eventually lead to improved clinical diagnosis, rehabilitation, and treatment.
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Affiliation(s)
- Dustin A Bruening
- Department of Exercise Sciences, Brigham Young University, 120F RB, Provo, UT, 84602, USA.
| | - Spencer R Petersen
- Department of Exercise Sciences, Brigham Young University, 120F RB, Provo, UT, 84602, USA
| | - Sarah T Ridge
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, 06117, USA
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Klenow TD, Lundstrom RL, Morris A, Patterson S, Simpson C, Trejo EG, Kannenberg A. An enhancement of the Genium™ microprocessor-controlled knee improves safety and different aspects of the perceived prosthetic experience for unilateral and bilateral users. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1342370. [PMID: 38798750 PMCID: PMC11122470 DOI: 10.3389/fresc.2024.1342370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024]
Abstract
Introduction Bilateral microprocessor-controlled prosthetic knee (MPK) users have unique needs in traversing environmental barriers compared to unilateral users. An enhancement to the Genium™/Genium X3™ MPK which included an updated ruleset, hydraulics, and new bilateral parameter presets was made to improve safety while stumbling and the smoothness of gait for all users while also improving the experience of bilateral users. The purpose of the study was to evaluate the effectiveness of the enhancements in a sample with unilateral and bilateral amputation. Methods A convenience sample of MPK users was recruited from two sites in the USA in two phases. Assessments included the L-Test of Functional Mobility, Activity-specific Balance Confidence Scale, Prosthetic Limb User Survey of Mobility, a study-specific questionnaire, and the Comparative Activities of Daily Living (ADL) Questionnaire. Statistical significance of extracted data was tested with the Wilcoxon Rank-Sum Test for independent data and Wilcoxon Signed-Rank for paired data with an a priori significance level of p < 0.05. Unilateral subjects were age-matched to the group of bilateral subjects for between-groups and within-groups analyses. Results Twenty-six subjects (n = 26) were enrolled. Stumble frequency reduced 85% from 16.0 ± 39.7 to 2.4 ± 2.3 (p = 0.008) between baseline and final assessment overall. The bilateral group reported 50% (p = 0.009) and 57% (p = 0.009) greater relative improvement in patient-reported ease and safety, respectively, of completing ADLs compared to the unilateral group. The unilateral group reported residual limb pain and low back pain reduced from 2.3 to 1.4 (p = 0.020) and 3.8 to 1.8 (p = 0.027), respectively, whereas the bilateral group did not. Discussion Substantial reductions in stumbles, residual limb pain, and back pain were shown overall. These reductions were driven by the unilateral group who also showed improvements in comfort, exertion, and concentration while walking. The enhancements to the knee likely reduced some gait asymmetry for unilateral users. Improvements in patient-reported ease and safety of completing ADLs were shown overall and were driven by the bilateral group. This study shows further improvement in patient experience is achievable through innovation in MPK technology even for patients who appear to be functioning well.
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Affiliation(s)
- Tyler D. Klenow
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
| | - Russell L. Lundstrom
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
| | - Arri Morris
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
| | - Stan Patterson
- Clinical Services Department, Prosthetic & Orthotic Associates, Orlando, FL, United States
| | - Chad Simpson
- Clinical Services Department, Dream Team Prosthetics, LLC, Duncan, OK, United States
| | - Ernesto G. Trejo
- Clinical Research & Services Department, Ottobock Healthcare Products GmbH, Vienna,Austria
| | - Andreas Kannenberg
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
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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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Maitland ME, Allyn KJ, Ficanha EM, Colvin JM, Wernke MM. Finite element simulation of frontal plane adaptation using full-foot, split-toe and cam-linkage designs in prosthetic feet. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2022; 34:14-21. [PMID: 35002181 PMCID: PMC8740950 DOI: 10.1097/jpo.0000000000000363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Murray E. Maitland
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Kaufman KR, Bernhardt K. Functional performance differences between carbon fiber and fiberglass prosthetic feet. Prosthet Orthot Int 2021; 45:205-213. [PMID: 33856155 DOI: 10.1097/pxr.0000000000000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with lower limb amputation require increased functionality. The largest category of feet for active individuals with a transtibial amputation is energy storage and return (ESR) feet. These feet are typically constructed of carbon fiber composite materials. Recently, a prosthetic foot composed of a fiberglass composite has emerged in the market. However, there are no comparative studies of these devices. OBJECTIVES Compare the biomechanical performance and prosthesis-related quality of life when using a fiberglass prosthetic foot design compared with traditional carbon fiber ESR designs. STUDY DESIGN This is a repeated-measures randomized cross-over trial. METHODS Gait analysis was performed on 10 experienced male subjects with unilateral transtibial amputations (K-level III) while walking on level ground and a ramp. Patient-reported outcomes were collected using the Prosthesis Evaluation Questionnaire. RESULTS Gait data demonstrated increased ankle dorsiflexion (P < .01), similar ankle moments (P = .07), and increased ankle power generation (P = .01) when using the fiberglass foot. The increased power generation occurred at the correct time in the gait cycle such that the timing and magnitude of peak knee flexion was unaffected (P > .19). The fiberglass foot had greater energy absorption during gait (P = .01) with no difference in energy return (P = .37). The subjects expressed improved prosthesis-related quality of life with the fiberglass foot (P = .01). CONCLUSIONS The findings of this study demonstrate that the new ESR foot comprising a fiberglass material had better performance than traditional designs using a carbon fiber material.
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Affiliation(s)
- Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Russell Esposito E, Ruble MD, Ikeda AJ, Wilken JM. The effect of custom carbon ankle-foot orthosis alignment on roll-over shape and center of pressure velocity. Prosthet Orthot Int 2021; 45:147-152. [PMID: 33225810 DOI: 10.1177/0309364620971407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Maintaining an optimal rolling of the foot over the ground is thought to increase the stability and efficiency of pathologic gait. Ankle-foot orthoses are often prescribed to improve gait mechanics in individuals with lower extremity injuries; however, their design may compromise how the foot rolls over the ground. OBJECTIVES The aim of this study was to investigate the effects of the sagittal plane ankle-foot orthosis alignment on roll-over shape and center of pressure velocity in individuals with lower limb reconstructions. STUDY DESIGN Randomized cross-over study with a control group comparison. METHODS In total, 12 individuals with lower limb reconstruction who used a custom carbon ankle-foot orthosis and 12 uninjured controls underwent gait analysis. Ankle-foot orthosis users were tested in their clinically-provided ankle-foot orthosis alignment, with an alignment that was 3° more plantarflexed, and with an alignment that was 3° more dorsiflexed. Components of roll-over shape and center of pressure velocity were calculated from heel strike on the ankle-foot orthosis limb to contralateral heel strike. RESULTS Roll-over shape radius was not affected by 3° changes to alignment and was not significantly different from controls. Aligning the ankle-foot orthosis in more dorsiflexion than clinically provided resulted in a smaller peak center of pressure velocity that occurred later in stance. CONCLUSION Individuals using custom carbon ankle-foot orthoses can accommodate 3° alterations in the dorsiflexion or plantarflexion alignment.
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Affiliation(s)
- Elizabeth Russell Esposito
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA.,Center for Limb Loss and Mobility, VA Puget Sound, Seattle, WA, USA.,Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Mitchell D Ruble
- Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA.,Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Andrea J Ikeda
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA.,Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA.,Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Jason M Wilken
- Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA.,The University of Iowa, Iowa City, IA, USA
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