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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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Norvell DC, Henderson AW, Morgenroth DC, Halsne BG, Turner AP, Biggs W, Czerniecki JM. The Effect of Prosthetic Limb Sophistication and Amputation Level on Self-reported Mobility and Satisfaction With Mobility. Arch Phys Med Rehabil 2024:S0003-9993(24)00905-5. [PMID: 38561145 DOI: 10.1016/j.apmr.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine if lower limb prosthesis (LLP) sophistication is associated with patient-reported mobility and/or mobility satisfaction, and if these associations differ by amputation level. DESIGN Cohort study that identified participants through a large national database and prospectively collected self-reported patient outcomes. SETTING The Veterans Administration (VA) Corporate Data Warehouse, the National Prosthetics Patient Database, participant mailings, and phone calls. PARTICIPANTS 347 Veterans who underwent an incident transtibial (TT) or transfemoral (TF) amputation due to diabetes and/or peripheral artery disease and received a qualifying LLP between March 1, 2018, and November 30, 2020. INTERVENTIONS Basic, intermediate, and advanced prosthesis sophistication was measured by the accurate and reliable PROClass system. MAIN OUTCOME MEASURE Patient-reported mobility using the advanced mobility subscale of the Locomotor Capabilities Index-5; mobility satisfaction using a 0-10-point Likert scale. RESULTS Lower limb amputees who received intermediate or advanced prostheses were more likely to achieve advanced mobility than those who received basic prostheses, with intermediate nearing statistical significance at nearly twice the odds (adjusted odds ratio (aOR)=1.8, 95% confidence interval (CI), .98-3.3; P=.06). The association was strongest in TF amputees with over 10 times the odds (aOR=10.2, 95% CI, 1.1-96.8; P=.04). The use of an intermediate sophistication prosthesis relative to a basic prosthesis was significantly associated with mobility satisfaction (adjusted β coefficient (aβ)=.77, 95% CI, .11-1.4; P=.02). A statistically significant association was only observed in those who underwent a TT amputation (aβ=.79, 95% CI, .09-1.5; P=.03). CONCLUSIONS Prosthesis sophistication was not associated with achieving advanced mobility in TT amputees but was associated with greater mobility satisfaction. In contrast, prosthesis sophistication was associated with achieving advanced mobility in TF amputees but was not associated with an increase in mobility satisfaction.
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Affiliation(s)
- Daniel C Norvell
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | - Alison W Henderson
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | - David C Morgenroth
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Beth G Halsne
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Wayne Biggs
- VA Puget Sound Health Care System, Seattle, WA
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Norvell DC, Biggs WT, Bott J, Henderson AW, Moore KP, Czerniecki JM. PROClass: The Development and Validation of a Novel Prosthetic Component Sophistication Classification System. Arch Rehabil Res Clin Transl 2023; 5:100273. [PMID: 37744202 PMCID: PMC10517350 DOI: 10.1016/j.arrct.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To develop a lower limb prosthesis (LLP) sophistication classification system that categorizes prosthetic component prescriptions into "basic," "intermediate," and "advanced" and assess its content validity, reliability, and accuracy. Design Classification development and validation study. Setting The Veterans Affairs (VA) Corporate Data Warehouse database and National Prosthetics Patient Database were used to identify patients undergoing their first amputation at the transtibial or transfemoral level due to diabetes or peripheral artery disease and to identify the associated codes for each LLP. Participants An expert panel of 6 nationally recognized certified prosthetists, a national expert in VA prosthetics data and coding, a physical medicine and rehabilitation physician, and an epidemiologist developed an LLP classification system (PROClass) using 30 transfemoral and transtibial lower limb amputees. Main Outcome Measures The expert panel reviewed 20 consecutive participants meeting study criteria for the development of the PROClass system and a subsequent 30 consecutive cases for assessing the inter- and intra-rater reliability and accuracy. Results The interrater and intrarater reliability was almost perfect with Gwet's AC1 values ranging from .82 to .96 for both expert panel members and research assistants. The accuracy of the research assistant's classifications to the "criterion standard" was excellent with Gwet's AC1 values ranging between .75 and .92. Conclusions PROClass is a pragmatic, reliable, and accurate prosthetic classification system with strong face validity that will enable the classification of prosthetic components used for large data set research aimed at evaluating important clinical questions such as the effects of sophistication on patient outcomes.
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Affiliation(s)
- Daniel C. Norvell
- VA Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | | | - Jeffrey Bott
- VA in the Orthotic, Prosthetic, and Orthic Clinical Services Program Office, Washington, DC
| | - Alison W. Henderson
- VA Puget Sound Health Care System, Seattle, WA
- VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | - Kathryn P. Moore
- VA Puget Sound Health Care System, Seattle, WA
- VA Seattle Epidemiologic Research and Information Center (ERIC), Seattle, WA
| | - Joseph M. Czerniecki
- VA Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
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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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Alzeer AM, Bhaskar Raj N, Shahine EM, Nadiah WA. Impacts of Microprocessor-Controlled Versus Non-microprocessor-Controlled Prosthetic Knee Joints Among Transfemoral Amputees on Functional Outcomes: A Comparative Study. Cureus 2022; 14:e24331. [PMID: 35607529 PMCID: PMC9123402 DOI: 10.7759/cureus.24331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Selecting a prosthetic knee mechanism is an important part of transfemoral (TF) amputee rehabilitation. Prosthetic knee joint selection depends on the users' gait and their energy consumption. This study compares the feedback of transfemoral prosthesis users based on the prosthetic knee design self-reporting responses using the Prosthetic Evaluation Questionnaire (PEQ) outcome measure. OBJECTIVE This study aims to assess the impact of using a microprocessor-controlled prosthetic knee (MCPK) compared with a non-microprocessor-controlled prosthetic knee (NMCPK); feedback on the amputee usage can improve the clinical decision for proper prosthetic knee joint selection. METHODS This is a cross-sectional study with a total of 76 adult unilateral transfemoral amputees classified into two groups. The participants in the first group (38) used the MCPK (Genium, Otto Bock, Minneapolis, MN, USA), and the participants in the second group (38) used the NMCPK (hydraulic and total knee joints). Enrolment was based on a sequence of appointments where all participants answered the PEQ, with different subscale questions including utility (UT), sounds (SO), appearance (AP), residual limb health (RL), frustration (FR), perceived response (PR), social burden (SB), ambulation (AM), and quality of life (QoL). PEQ was filled out during the follow-up appointments at the prosthetic clinic through a visual analog scale (VAS). All data entered into a database were analyzed. RESULT The MCPK participants have significantly improved utility, appearance, ambulation, and total PEQ score, the same results as the male participants. Middle-adulthood (25-40 years) MCPK participants have a significant p-value in the score of utility, frustration, ambulation, and total PEQ score compared to early-adulthood (18-24 years) and late-adulthood (41-60 years) participants. Also, there was a significant improvement in the p-value in ambulation scores in participants using MCPK with amputations caused by diseases compared to amputations caused by trauma and congenital cause. CONCLUSION Transfemoral amputee prosthesis utility, natural gait, and ambulation improved when using MCPK compared to when using NMCPK during prosthetic rehabilitation.
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Affiliation(s)
- Abdallah M Alzeer
- School of Rehabilitation Science, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS
- Prosthetics and Orthotics, Sultan Bin Abdul Aziz Humanitarian City, Riyadh, SAU
| | - Naresh Bhaskar Raj
- School of Rehabilitation Science, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS
| | - Enas M Shahine
- Medical Affairs, Sultan Bin Abdul Aziz Humanitarian City, Riyadh, SAU
| | - Wan-Arfah Nadiah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS
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De Marchis C, Ranaldi S, Varrecchia T, Serrao M, Castiglia SF, Tatarelli A, Ranavolo A, Draicchio F, Lacquaniti F, Conforto S. Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:804746. [PMID: 36189078 PMCID: PMC9397865 DOI: 10.3389/fresc.2022.804746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Prosthetic gait implies the use of compensatory motor strategies, including alterations in gait biomechanics and adaptations in the neural control mechanisms adopted by the central nervous system. Despite the constant technological advancements in prostheses design that led to a reduction in compensatory movements and an increased acceptance by the users, a deep comprehension of the numerous factors that influence prosthetic gait is still needed. The quantitative prosthetic gait analysis is an essential step in the development of new and ergonomic devices and to optimize the rehabilitation therapies. Nevertheless, the assessment of prosthetic gait is still carried out by a heterogeneous variety of methodologies, and this limits the comparison of results from different studies, complicating the definition of shared and well-accepted guidelines among clinicians, therapists, physicians, and engineers. This perspective article starts from the results of a project funded by the Italian Worker's Compensation Authority (INAIL) that led to the generation of an extended dataset of measurements involving kinematic, kinetic, and electrophysiological recordings in subjects with different types of amputation and prosthetic components. By encompassing different studies published along the project activities, we discuss the specific information that can be extracted by different kinds of measurements, and we here provide a methodological perspective related to multimodal prosthetic gait assessment, highlighting how, for designing improved prostheses and more effective therapies for patients, it is of critical importance to analyze movement neural control and its mechanical actuation as a whole, without limiting the focus to one specific aspect.
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Affiliation(s)
- Cristiano De Marchis
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
- Department of Engineering, University of Messina, Messina, Italy
- *Correspondence: Cristiano De Marchis
| | - Simone Ranaldi
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
| | - Tiwana Varrecchia
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Mariano Serrao
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Stefano Filippo Castiglia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonella Tatarelli
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Alberto Ranavolo
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Francesco Draicchio
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Francesco Lacquaniti
- Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Conforto
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
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Gaillard J, Fouasson-Chailloux A, Eveno D, Bokobza G, Da Costa M, Heidar R, Pouedras M, Nich C, Gouin F, Crenn V. Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review. Front Surg 2022; 8:820019. [PMID: 35071319 PMCID: PMC8776644 DOI: 10.3389/fsurg.2021.820019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022] Open
Abstract
Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.
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Affiliation(s)
- Jean Gaillard
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- Physical and Rehabilitation Department, University Hospital Saint Jacques, CHU de Nantes, Nantes, France
| | - Dominique Eveno
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Guillaume Bokobza
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Marta Da Costa
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Romain Heidar
- Anesthesia and Resuscitation Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Marie Pouedras
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Christophe Nich
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
- Laboratoire d'étude des Sarcomes Osseux et Remodelage des Tissus Calcifiés, PhyOs, INSERM UMR 1238, Université de Nantes, Nantes, France
| | - François Gouin
- Department of Surgery, Centre de lutte Contre le CancerLéon Bérard, Lyon, France
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
- Laboratoire d'étude des Sarcomes Osseux et Remodelage des Tissus Calcifiés, PhyOs, INSERM UMR 1238, Université de Nantes, Nantes, France
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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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9
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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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