1
|
Fehr KH, Kent JA, Major MJ, Adamczyk PG. Changes in Dynamic Mean Ankle Moment Arm in Unimpaired Walking Across Speeds, Ramps, and Stairs. J Biomech Eng 2024; 146:094501. [PMID: 38581371 DOI: 10.1115/1.4065269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2024] [Indexed: 04/08/2024]
Abstract
Understanding the natural biomechanics of walking at different speeds and activities is crucial to develop effective assistive devices for persons with lower-limb impairments. While continuous measures such as joint angle and moment are well-suited for biomimetic control of robotic systems, whole-stride summary metrics are useful for describing changes across behaviors and for designing and controlling passive and semi-active devices. Dynamic mean ankle moment arm (DMAMA) is a whole-stride measure representing the moment arm of the ground reaction impulse about the ankle joint-effectively, how "forefoot-dominated" or "hindfoot-dominated" a movement is. DMAMA was developed as a target and performance metric for semi-active devices that adjust once per stride. However, for implementation in this application, DMAMA must be characterized across various activities in unimpaired individuals. In our study, unimpaired participants walked at "slow," "normal," and "fast" self-selected speeds on level ground and at a normal self-selected speed while ascending and descending stairs and a 5-degree incline ramp. DMAMA measured from these activities displayed a borderline-significant negative sensitivity to walking speed, a significant positive sensitivity to ground incline, and a significant decrease when ascending stairs compared to descending. The data suggested a nonlinear relationship between DMAMA and walking speed; half of the participants had the highest average DMAMA at their "normal" speed. Our findings suggest that DMAMA varies substantially across activities, and thus, matching DMAMA could be a valuable metric to consider when designing biomimetic assistive lower-limb devices.
Collapse
Affiliation(s)
- Katherine Heidi Fehr
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53705
| | - Jenny A Kent
- Department of Physical Therapy, University of Nevada Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154
| | - Matthew J Major
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208; Jesse Brown Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611
| | - Peter Gabriel Adamczyk
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave., Rm. 3039, Madison, WI 53705
| |
Collapse
|
2
|
Kent JA, Carnahan KJ, Major MJ. Socket-residuum coupling integrity affects perception of external stimuli: Effects of altering the transtibial interface using vacuum-assisted suspension. Prosthet Orthot Int 2024; 48:184-189. [PMID: 37498767 DOI: 10.1097/pxr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/09/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Relative movement between the socket and residual limb can impair function in prosthesis users. It is plausible that, in addition to its mechanical effect, the integrity of the socket-residuum interface influences the ability of an individual to sense tactile cues through the prosthesis. Vacuum-assisted suspension (VAS) has been shown to reduce relative movement at this interface, providing a means to test this premise. The purpose of this pilot study was to assess the effects of altering socket-residuum interface integrity through the VAS pressure level on the thresholds of perception of an externally applied vibration stimulus. METHODS Seven unilateral transtibial prosthesis users participated. Socket-residual limb integrity was altered using the VAS subatmospheric (vacuum) pressure level. Vibration perception tests were conducted at low, mid, and high vacuum levels, targeting 0, 8, and 19 in Hg respectively, and performed in partially loaded and fully loaded conditions. Vibration intensity was increased using a dial until participants delivered a verbal signal indicating it was perceptible, and the nominal intensity was recorded. RESULTS Intensity thresholds decreased (ie, sensitivity increased) from low to high vacuum settings when fully loaded ( P = 0.008). Differences when partially loaded were nonsignificant and variable across participants. CONCLUSION This study provides preliminary evidence that altering the integrity between the socket and residual limb by modifying the vacuum level affects sensation related to the external environment experienced through the prosthesis, although translation of these findings to real-world stimuli remains to be tested.
Collapse
Affiliation(s)
- Jenny A Kent
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
| | - Kristin J Carnahan
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
| |
Collapse
|
3
|
Kohler F, Halford GRJ, Lukin M, Hafner BJ, Boone DA, Desmond DM, Franchignoni F, Gailey RS, Hagberg K, Major MJ, Resnik L, Tan JM. Categorization and recommendations for outcome measures for lower limb absence by an expert panel. Prosthet Orthot Int 2023; 47:565-574. [PMID: 37878250 DOI: 10.1097/pxr.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Understanding the psychometric strengths and limitations of outcome measures for use with people with lower limb absence (LLA) is important for selecting measures suited to evaluating patient outcomes, answering clinical and research questions, and informing health care policy. The aim of this project was to review the current psychometric evidence on outcome measures in people with LLA to determine which measures should be included in a stakeholder consensus process. METHODS An expert panel was assembled, and a 3-stage review process was used to categorize outcome measures identified in a systematic literature review into 3 distinct categories (recommended for measures with better than adequate psychometric properties; recommended with qualification; and unable to recommend). Panelists were asked to individually categorize measures based on results of a systematic review of identified measures' psychometric properties. Each measure's final categorization was based on ≥70% agreement by all panelists. RESULTS No outcome measure attained the ≥70% consensus threshold needed to achieve a rating of "recommend." Hence, panelists suggested combining "recommend" and "recommend with qualifications" into a single category of "recommend with qualifications." Using this approach, consensus was reached for 59 of 60 measures. Consensus could not be reached on 1 outcome measure (socket comfort score). Thirty-six outcome measures were categorized as "unable to recommend" based on available evidence; however, 23 (12 patient-reported measures and 11 performance-based measures) demonstrated adequate psychometric properties in LLA samples and were thus rated as "recommend with qualification" by the expert panel. The panel of experts were able to recommend 23 measures for inclusion in the subsequent stakeholder review. A key strength of this process was bringing together international researchers with extensive experience in developing and/or using LLA outcome measures who could assist in identifying psychometrically sound measures to include in a subsequent stakeholder consensus process. CONCLUSION The above categorizations represent the current state of psychometric evidence on outcome measures for people with LLA and hence may change over time as additional research becomes available. The results will be used to achieve wider consensus from clinicians, health policymakers, health clinic managers, researchers, and end users (i.e., individuals with LLA) on outcome measures for the International Society of Prosthetics and Orthotics lower limb Consensus Outcome Measures for Prosthetic and Amputation ServiceS.
Collapse
Affiliation(s)
- Friedbert Kohler
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- South Western Sydney Clinical School, Medicine and Health, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Braeside Hospital, HammondCare Health, Sydney, Australia
| | - Gregory R J Halford
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Martina Lukin
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- South Western Sydney Clinical School, Medicine and Health, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Braeside Hospital, HammondCare Health, Sydney, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Orthocare Innovations, Edmonds, WA
- Prosthetics and Orthotics International, Brussels, Belgium
- Exceed Worldwide, Belfast, United Kingdom
- Assisting Living and Learning Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
- Department of Orthopaedics, Sahlgrenska University Hospital and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, Chicago, IL
- Providence VA Medical Center, Providence, RI
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - David A Boone
- Orthocare Innovations, Edmonds, WA
- Prosthetics and Orthotics International, Brussels, Belgium
- Exceed Worldwide, Belfast, United Kingdom
| | - Deirdre M Desmond
- Assisting Living and Learning Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Franco Franchignoni
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Robert S Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
| | - Kerstin Hagberg
- Department of Orthopaedics, Sahlgrenska University Hospital and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, Chicago, IL
| | - Linda Resnik
- Providence VA Medical Center, Providence, RI
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI
| | - Jade M Tan
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Providence VA Medical Center, Providence, RI
| |
Collapse
|
4
|
Russell Esposito E, Hansen AH, Slater BS, Major MJ, Muschler K, Ikeda AJ, Erbes C. Footwear limitations in women prosthesis users relate to more than preference. Prosthet Orthot Int 2023; 47:511-518. [PMID: 36629586 DOI: 10.1097/pxr.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The option to wear desired footwear may be an important part of community reintegration after lower-limb amputation. OBJECTIVES This study explored outcomes related to footwear, health, and participation in women Veterans with lower-limb amputation. METHODS A cross-sectional questionnaire was mailed to all women Veterans age 18-82 years with major lower-limb amputation(s) who had received prosthetics services in the US Department of Veterans Affairs (N = 538). The questionnaire assessed Perceived Challenges (including clothing limitations, prosthetic foot limitations [width, height, and shape], and shoe avoidance for safety concerns), type of footwear used and preference, and included subscales from the Patient-Reported Outcome Measurement Information System, Amputee Body Image Scale Prosthetic Limb Users' Survey of Mobility, Community Participation Index, Activities-Specific Balance Confidence Scale, and Prosthesis Evaluation Questionnaire. Bivariate correlations examined relationships between a composite measure of Perceived Challenges and patient-reported outcomes. RESULTS One hundred questionnaires were returned (18.6% response rate; 3 excluded for limited prosthesis use). The Perceived Challenges score was significantly correlated with scores for the Amputee Body Image Scale-Revised (r = 0.24, p = 0.019), Patient-Reported Outcome Measurement Information System (ability to participate: r = -0.25, p = 0.014), Prosthesis Evaluation Questionnaire (utility: r = -0.32, p = 0.001, appearance: r = -0.48, p < 0.001), Activities-Specific Balance Confidence Scale (r = -0.20, p = 0.046), and Prosthetic Limb Users' Survey of Mobility (r = -0.21, p = 0.036), but not depression or anxiety. CONCLUSIONS Women who have greater issues with how their prosthesis affects the shoes and clothing they can wear also have poorer body image, reduced functional capabilities, and lower reported participation in activities. Improved prosthetic foot design may help to improve social participation and other important outcomes for women prosthesis users.
Collapse
Affiliation(s)
- Elizabeth Russell Esposito
- Extremity Trauma and Amputation Center of Excellence (EACE), Ft. Sam Houston, TX, USA
- Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
- Military Operational Medicine Research Program, Ft. Detrick, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | | | - Matthew J Major
- Northwestern University, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
| | | | | | - Christopher Erbes
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
5
|
Major MJ, Stine RL. Sensorimotor function and standing balance in older adults with transtibial limb loss. Clin Biomech (Bristol, Avon) 2023; 109:106104. [PMID: 37757679 DOI: 10.1016/j.clinbiomech.2023.106104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Limited research has focused on older prosthesis users despite the expected compounded effects of age and amputation on sensorimotor function, balance, and falls. This study compared sensorimotor factors and standing balance between older individuals with and without transtibial amputation, hypothesizing that prosthesis users would demonstrate worse sensorimotor function. Secondarily we assessed the relationship between standing balance and somatosensation in prosthesis users. METHODS Thirteen persons with unilateral transtibial amputation (71.7 years) and 10 able-bodied controls (71.7 years) participated in this cross-sectional observational study. Passive joint range-of-motion, muscle strength, proprioception (joint position sense), tactile sensitivity, and standing balance (center-of-pressure sway) were compared between groups. A multiple linear regression analysis assessed the relationship between proprioception and balance (without vision) in prosthesis users. FINDINGS Our hypotheses were generally not supported, with the only differences being reduced joint range-of-motion and strength in prosthesis users (with large effect sizes), but comparable sensation and balance. Notably, prosthesis users demonstrated better proprioception than controls as reflected through better joint position sense when the limb was non-weight bearing. Worse amputated limb proprioception was associated with better standing balance in prosthesis users. INTERPRETATION Older prosthesis users have impaired passive joint motion and muscle strength compared to controls that could challenge their ability to position and control the amputated limb to avoid falls during daily activities. However, their better amputated limb proprioception might help counteract those limitations by leveraging sensory feedback from the suspended limb. The relationship between amputated limb proprioception and standing balance suggests a nuanced relationship that warrants further study.
Collapse
Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, USA.
| | | |
Collapse
|
6
|
Rosenblatt NJ, Major MJ, Manesh B, Schneider K, Miller SA. Validating a fear-of-falling-related activity avoidance scale in lower limb prosthesis users. PM R 2023. [PMID: 37632836 PMCID: PMC10895070 DOI: 10.1002/pmrj.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/05/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Limited available data suggest that fear of falling (FoF) may be common among lower limb prosthesis users (LLPUs) and associated with negative rehabilitation outcomes. The impact of FoF on outcomes may be exacerbated when fear leads to self-imposed declines in activity. There is a need to identify the validity of fear-of-falling-related activity avoidance scales in LLPUs. OBJECTIVE To evaluate the convergent, discriminant, and known-group construct validity of the modified Survey of Activities and FoF in the Elderly (mSAFE) for LLPUs. Secondarily, we sought to determine if the mSAFE scale could be reduced without losing information regarding construct validity. DESIGN Online survey. SETTING Not applicable. PARTICIPANTS Fifty-nine persons with unilateral or bilateral amputation at the transtibial or transfemoral level, with ≥6 months experience using a definitive prosthesis for activities other than transfers. INTERVENTION Participants completed an online survey that consisted of the mSAFE and questions to assess FoF (yes/no), fear-of-falling-related activity avoidance (yes/no), as well as previously validated scales capturing related and unrelated constructs. T-tests were used to compare mSAFE score between yes/no respondents for known-group construct validity. Correlations between mSAFE and previously validated surveys assessed convergent and discriminant validity. Analyses were repeated on a reduced number of mSAFE items following a redundancy analysis. MAIN OUTCOME MEASURES Not applicable. RESULTS Significant correlation coefficients of |0.440-0.825| were found for convergent validity with evidence of known-group construct validity (p < .021 for all comparisons). There was evidence for discriminant validity, with non-significant associations for two-of-three correlations. Results from validity analyses for a shortened 6-item mSAFE were similar to that for the full scale. CONCLUSION This study provided initial evidence regarding validity of the mSAFE as a measure to assess fear-of-falling-related activity avoidance in LLPUs. A 6-item scale may be appropriate if the full scale would be taxing or time-consuming.
Collapse
Affiliation(s)
- Noah J Rosenblatt
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Bobak Manesh
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Kristin Schneider
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Steven A Miller
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| |
Collapse
|
7
|
Hisano G, Murata H, Kobayashi T, Major MJ, Nakashima M, Hobara H. Dynamic balance during walking in transfemoral prosthesis users: step-to-step changes in whole-body and segment angular momenta. IEEE Trans Neural Syst Rehabil Eng 2023; PP:1-1. [PMID: 37379180 DOI: 10.1109/tnsre.2023.3290320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Transfemoral prosthesis users (TFPUs) typically have a high risk of balance loss and falling. Whole-body angular momentum (→HWB) is a common measure for assessing dynamic balance during human walking. However, little is known about how unilateral TFPUs maintain this dynamic balance through segment-to-segment cancellation strategies. Better understanding of the underlying mechanisms of dynamic balance control in TFPUs is required to improve gait safety. Thus, this study aimed to evaluate dynamic balance in unilateral TFPUs during walking at a self-selected constant speed. Fourteen unilateral TFPUs and fourteen matched controls performed level-ground walking at a comfortable speed on a straight, 10-m-long walkway. In the sagittal plane, the TFPUs had a greater and smaller range of →HWB compared to controls during intact and prosthetic steps, respectively. Further, the TFPUs generated greater average positive and negative →HWB than did the controls during intact and prosthetic steps, respectively, which may necessitate larger step-to-step postural changes in the forward and backward rotation about the body center of mass (COM). In the transverse plane, no significant difference was observed in the range of →HWB between groups. However, the TFPUs displayed smaller negative average →HWB in the transverse plane than did the controls. In the frontal plane, the TFPUs and controls demonstrated similar range of →HWB and step-to-step whole-body dynamic balance owing to the employment of different segment-to-segment cancellation strategies. Our findings should be interpreted and generalized with caution for the demographic features in our participants.
Collapse
|
8
|
Kent JA, Carnahan KJ, Stine RL, Hansen AH, Esposito ER, Major MJ. Effects of footwear on the gait kinematics of women with unilateral transtibial amputation: an observational case series. Disabil Rehabil 2023; 45:322-329. [PMID: 34978960 DOI: 10.1080/09638288.2021.2022782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Prosthesis geometry and behaviour limit the footwear options available to women. Using a commercially available prosthetic foot that permits user-alignment to accommodate shoes with different heel heights, we investigated the effect of footwear on gait kinematics, with and without adjustment for differences in heel-forefoot differential. MATERIALS AND METHODS Three women with transtibial amputation walked at a self-selected pace, first in an athletic shoe (prosthetist-aligned; baseline condition), then (i) in a flatter shoe without realigning the prosthesis, and (ii) in flat and heeled shoes following user re-alignment. Kinematics in each condition were compared to baseline. RESULTS Baseline gait patterns were highly variable across participants. Gait was slower in comparison to baseline in all conditions, but movement compensations varied across participants. An increased lower limb extension tendency was evident with the misaligned prosthesis. With user re-alignment to accommodate the shoe there were fewer deviations from baseline, however kinematic differences remained in both the flat and heeled shoes. CONCLUSIONS The user-alignment feature of the prosthetic foot reduced the effect of a change in footwear on kinematics, and permitted walking in heeled shoes when it might otherwise not be possible. Persistence of some deviations suggests differences in walking task demand remained despite adjustment.Implications for rehabilitationPermitting prosthesis users to don footwear of choice may improve body image, well-being and quality of life following amputation.Prosthetic feet that permit user ankle adjustment can reduce gait deviations associated with a change in footwear heel height, although kinematic adaptations are individual.
Collapse
Affiliation(s)
- Jenny A Kent
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Kristin J Carnahan
- Department of Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Biomedical Engineering, University of Minnesota, MN, USA
| | - Elizabeth Russell Esposito
- VA Puget Sound, Seattle, WA, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Fort Sam Houston, TX, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew J Major
- Department of Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| |
Collapse
|
9
|
Vaca M, Stine R, Hammond P, Cavanaugh M, Major MJ, Gard SA. The Effect of Prosthetic Ankle Dorsiflexion Stiffness on Standing Balance and Gait Biomechanics in Individuals with Unilateral Transtibial Amputation. J Prosthet Orthot 2022; 34:10.1097/JPO.0000000000000451. [PMID: 36407034 PMCID: PMC9670249 DOI: 10.1097/jpo.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Miguel Vaca
- Department of Biomedical Engineering - Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| | | | | | - Michael Cavanaugh
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| | - Matthew J. Major
- Department of Biomedical Engineering - Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| | - Steven A. Gard
- Department of Biomedical Engineering - Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
10
|
Jan YK, Major MJ, Pu F, Sonenblum SE. Editorial: Soft Tissue Biomechanics in Wound Healing and Prevention. Front Bioeng Biotechnol 2022; 10:897860. [PMID: 35449596 PMCID: PMC9017806 DOI: 10.3389/fbioe.2022.897860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- *Correspondence: Yih-Kuen Jan,
| | - Matthew J. Major
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, United States
- Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Fang Pu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Sharon Eve Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| |
Collapse
|
11
|
Fatone S, Stine R, Caldwell R, Angelico J, Gard SA, Oros M, Major MJ. Comparison of Ischial Containment and Sub-Ischial Sockets Effect on Gait Biomechanics in People with Transfemoral Amputation: a randomized crossover trial. Arch Phys Med Rehabil 2022; 103:1515-1523. [DOI: 10.1016/j.apmr.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/19/2022] [Accepted: 02/14/2022] [Indexed: 11/02/2022]
|
12
|
Major MJ, Quinlan J, Hansen AH, Russell Esposito E. Effects of women’s footwear on the mechanical function of heel-height accommodating prosthetic feet. PLoS One 2022; 17:e0262910. [PMID: 35073370 PMCID: PMC8786192 DOI: 10.1371/journal.pone.0262910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022] Open
Abstract
The loaded mechanical function of transtibial prostheses that result from the clinical assembly, tuning, and alignment of modular prosthetic components can directly influence an end user’s biomechanics and overall mobility. Footwear is known to affect prosthesis mechanical properties, and while the options of footwear are limited for most commercial feet due to their fixed geometry, there exists a selection of commercial prosthetic feet that can accommodate a moderate rise in heel height. These feet are particularly relevant to women prosthesis users who often desire to don footwear spanning a range of heel heights. The aim of this study was to assess the effects of adding women’s footwear (flat, trainer, 5.08 cm heel) on the mechanical properties (deformation and energy efficiency) of four models of heel-height accommodating prosthetic feet. Properties were measured through loading-unloading at simulated initial contact, midstance and terminal stance orientations with a universal materials test system, and statistically compared to a barefoot condition. Results suggest that the addition of footwear can alter the level of foot deformation under load, which may be a function of the shoe and alignment. Moreover, while each foot displayed different amounts of energy storage and return, the addition of footwear yielded similar levels of energy efficiency across foot models. Overall, prosthesis users who don shoes of varying heel heights onto adjustable prosthetic feet and their treating clinicians should be aware of the potential changes in mechanical function that could affect the user experience.
Collapse
Affiliation(s)
- Matthew J. Major
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
- Jesse Brown VA Medical Center, Chicago, IL, United States of America
- * E-mail:
| | - Julia Quinlan
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States of America
| | - Andrew H. Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America
- University of Minnesota, Minneapolis, MN, United States of America
| | - Elizabeth Russell Esposito
- DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), San Antonio, TX, United States of America
- Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, United States of America
- University of Washington, Seattle, WA, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| |
Collapse
|
13
|
Kaul M, Sunkara S, Major MJ, Gordon KE, Rubinstein I. Proposed novel treatment paradigm of aberrant gait and balance kinematics in patients with severe COPD. Respirology 2021; 26:914-916. [PMID: 34382283 DOI: 10.1111/resp.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Malvika Kaul
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Medical Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Sai Sunkara
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Medical Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Matthew J Major
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Keith E Gordon
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Edward Hines, Jr. VA Medical Center, Chicago, Illinois, USA
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Medical Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Research Services, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| |
Collapse
|
14
|
Maun JA, Gard SA, Major MJ, Takahashi KZ. Reducing stiffness of shock-absorbing pylon amplifies prosthesis energy loss and redistributes joint mechanical work during walking. J Neuroeng Rehabil 2021; 18:143. [PMID: 34548080 PMCID: PMC8456590 DOI: 10.1186/s12984-021-00939-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A shock-absorbing pylon (SAP) is a modular prosthetic component designed to attenuate impact forces, which unlike traditional pylons that are rigid, can compress to absorb, return, or dissipate energy. Previous studies found that walking with a SAP improved lower-limb prosthesis users' comfort and residual limb pain. While longitudinal stiffness of a SAP has been shown to affect gait kinematics, kinetics, and work done by the entire lower limb, the energetic contributions from the prosthesis and the intact joints have not been examined. The purpose of this study was to determine the effects of SAP stiffness and walking speed on the mechanical work contributions of the prosthesis (i.e., all components distal to socket), knee, and hip in individuals with a transtibial amputation. METHODS Twelve participants with unilateral transtibial amputation walked overground at their customary (1.22 ± 0.18 ms-1) and fast speeds (1.53 ± 0.29 ms-1) under four different levels of SAP stiffness. Power and mechanical work profiles of the leg joints and components distal to the socket were quantified. The effects of SAP stiffness and walking speed on positive and negative work were analyzed using two-factor (stiffness and speed) repeated-measure ANOVAs (α = 0.05). RESULTS Faster walking significantly increased mechanical work from the SAP-integrated prosthesis (p < 0.001). Reducing SAP stiffness increased the magnitude of prosthesis negative work (energy absorption) during early stance (p = 0.045) by as much as 0.027 Jkg-1, without affecting the positive work (energy return) during late stance (p = 0.159), suggesting a damping effect. This energy loss was partially offset by an increase in residual hip positive work (as much as 0.012 Jkg-1) during late stance (p = 0.045). Reducing SAP stiffness also reduced the magnitude of negative work on the contralateral sound limb during early stance by 11-17% (p = 0.001). CONCLUSIONS Reducing SAP stiffness and faster walking amplified the prostheses damping effect, which redistributed the mechanical work, both in magnitude and timing, within the residual joints and sound limb. With its capacity to absorb and dissipate energy, future studies are warranted to determine whether SAPs can provide additional user benefit for locomotor tasks that require greater attenuation of impact forces (e.g., load carriage) or energy dissipation (e.g., downhill walking).
Collapse
Affiliation(s)
- Jenny Anne Maun
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Steven A Gard
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Kota Z Takahashi
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| |
Collapse
|
15
|
Kent JA, Arelekatti VNM, Petelina NT, Johnson WB, Brinkmann JT, Winter AG, Major MJ. Knee Swing Phase Flexion Resistance Affects Several Key Features of Leg Swing Important to Safe Transfemoral Prosthetic Gait. IEEE Trans Neural Syst Rehabil Eng 2021; 29:965-973. [PMID: 34018934 PMCID: PMC8223905 DOI: 10.1109/tnsre.2021.3082459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We systematically investigate in-vivo the effect of increasing prosthetic knee flexion damping on key features of the swing phase of individuals with transfemoral amputation during walking. Five experienced prosthesis users walked using a prototype device in a motion capture laboratory. A range of interchangeable hydraulic rotary dampers was used to progressively modify swing phase flexion resistance in isolation. Toe clearance (TC; vertical distance toe to floor), effective leg length (ELL; distance hip to toe), and knee flexion angle during swing phase were computed, alongside the sensitivities of vertical toe position to angular displacements at the hip, knee and ankle. Key features of these profiles were compared across 5 damping conditions. With higher damping, knee extension occurred earlier in swing phase, promoting greater symmetry. However, with implications for toe catch, minimum TC reduced, and minimum TC and maximum ELL occurred earlier; temporally closer to mid-swing, when the limb must pass the stance limb. Further, TC became less sensitive to changes in hip flexion, suggesting a lesser ability to control toe clearance without employing proximal or contralateralcompensations.Thereisatrade-offbetweenkeyfeaturesrelated to gait safety when selecting an appropriate resistance for a mechanical prosthetic knee. In addition to highlighting broader implications surrounding swing phase damping selection for the optimization of mechanical knees, this work reveals design considerations that may be of utility in the formulation of control strategies for computerized devices.
Collapse
|
16
|
Olesnavage KM, Prost V, Johnson WB, Major MJ, Winter AG. Experimental Demonstration of the Lower Leg Trajectory Error Framework Using Physiological Data as Inputs. J Biomech Eng 2021; 143:1087600. [PMID: 33006368 DOI: 10.1115/1.4048643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 11/08/2022]
Abstract
While many studies have attempted to characterize the mechanical behavior of passive prosthetic feet to understand their influence on amputee gait, the relationship between mechanical design and biomechanical performance has not yet been fully articulated from a fundamental physics perspective. A novel framework, called lower leg trajectory error (LLTE) framework, presents a means of quantitatively optimizing the constitutive model of prosthetic feet to match a reference kinematic and kinetic dataset. This framework can be used to predict the required stiffness and geometry of a prosthesis to yield a desired biomechanical response. A passive prototype foot with adjustable ankle stiffness was tested by a unilateral transtibial amputee to evaluate this framework. The foot condition with LLTE-optimal ankle stiffness enabled the user to replicate the physiological target dataset within 16% root-mean-square (RMS) error. Specifically, the measured kinematic variables matched the target kinematics within 4% RMS error. Testing a range of ankle stiffness conditions from 1.5 to 24.4 N·m/deg with the same user indicated that conditions with lower LLTE values deviated the least from the target kinematic data. Across all conditions, the framework predicted the horizontal/vertical position, and angular orientation of the lower leg during midstance within 1.0 cm, 0.3 cm, and 1.5 deg, respectively. This initial testing suggests that prosthetic feet designed with low LLTE values could offer benefits to users. The LLTE framework is agnostic to specific foot designs and kinematic/kinetic user targets, and could be used to design and customize prosthetic feet.
Collapse
Affiliation(s)
- Kathryn M Olesnavage
- GEAR Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Victor Prost
- GEAR Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - William Brett Johnson
- GEAR Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Matthew J Major
- Jesse Brown VA Medical Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60208
| | - Amos G Winter
- GEAR Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| |
Collapse
|
17
|
Pace A, Howard D, Gard SA, Major MJ. Using a Simple Walking Model to Optimize Transfemoral Prostheses for Prosthetic Limb Stability-A Preliminary Study. IEEE Trans Neural Syst Rehabil Eng 2020; 28:3005-3012. [PMID: 33275584 DOI: 10.1109/tnsre.2020.3042626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The interaction between the prescribed prosthetic knee and foot is critical to the safety of transfemoral prosthesis users primarily during the stance phase of the gait, when knee buckling can result in a fall. Nonetheless, there is still a need for standardized approaches to quantify the effects of prosthetic component interactions and associated mechanical function on user gait biomechanics. A numerical model was defined to simulate sagittal plane prosthetic limb stance based on a single inverted pendulum and predict effects of prosthetic knee alignment and foot stiffness on knee moment to identify optimal solutions. Model validation against laboratory gait data suggests it is appropriate to preliminary simulate prosthetic gait during single-limb support, when prosthetic knee stability may be most at risk given reliance on the prosthetic limb and proximal anatomy, but only for knees with flexion smaller than 4°. Model predictions identify a solution space containing those combinations of knee alignment and foot stiffness (via roll-over shape radius) guaranteeing knee stability in early and mid- single-limb support, whilst facilitating knee break at the end of it. Specifically, a posterior to in-line knee alignment should be combined with low to medium ankle-foot stiffness, whereas anterior knee alignments and rigid feet should likely be avoided. Clinicians can use these solution spaces to optimize transfemoral prostheses including knees with little to no change in stance flexion, ensuring the safety of users. Model prediction can further inform in-vivo investigations on commercial device interactions, providing evidence for future Clinical Practice Guidelines on transfemoral prostheses design.
Collapse
|
18
|
Major MJ, Serba CK, Gordon KE. Perturbation recovery during walking is impacted by knowledge of perturbation timing in below-knee prosthesis users and non-impaired participants. PLoS One 2020; 15:e0235686. [PMID: 32658907 PMCID: PMC7357748 DOI: 10.1371/journal.pone.0235686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 06/27/2020] [Indexed: 11/18/2022] Open
Abstract
Previous research found that below-knee prosthesis users proactively increase their lateral margin-of-stability on their impaired side in anticipation of an impending perturbation when the timing is predictable and potentially directed toward the impaired limb. While knowledge of perturbation timing and direction influences proactive strategies, the consequences of such knowledge and anticipatory behavior on recovery from perturbations is unclear. This study characterized center-of-mass (CoM) dynamics of below-knee prosthesis users and non-impaired controls following a lateral perturbation when the perturbation direction is known but a priori knowledge of the timing of perturbation is either known or unknown. Across groups, CoM displacement during perturbation exposure increased when directed towards the impaired or non-dominant limb with no influence of timing knowledge. In addition, peak CoM displacement was less with known timing irrespective of the perturbation direction. Generally, the CoM displacement during perturbation exposure correlated well with the CoM medial-lateral velocity during unperturbed walking, supporting evidence that human response dynamics to lateral perturbations are influenced by the instantaneous state of the body's momentum.
Collapse
Affiliation(s)
- Matthew J. Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
- Jesse Brown VA Medical Center, Chicago, Illinois, United States of America
- Edward Hines Jr. VA Medical Center, Hines, Illinois, United States of America
- * E-mail:
| | - Chelsi K. Serba
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States of America
| | - Keith E. Gordon
- Edward Hines Jr. VA Medical Center, Hines, Illinois, United States of America
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America
| |
Collapse
|
19
|
Kent JA, Major MJ. Asymmetry of mass and motion affects the regulation of whole-body angular momentum in individuals with upper limb absence. Clin Biomech (Bristol, Avon) 2020; 76:105015. [PMID: 32361516 DOI: 10.1016/j.clinbiomech.2020.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a high fall prevalence in individuals with upper limb absence, which may be related to a momentum imbalance resulting from the loss of all or part of one arm. The purpose of this study was to characterise whole-body angular momentum in individuals with upper limb absence during walking, and determine the effect of restoring the mass and inertial properties of the impaired side with a mock prosthesis. METHODS Ten individuals with unilateral upper limb absence walked at self-selected speeds, with and without a mock prosthesis. For each condition, whole-body angular momentum range was computed during ten strides; in the first 50% of the stride bilaterally, and over the whole stride. Two-way repeated measures ANOVAs were used to assess the main effect of side and the interaction effect with prosthesis condition on the 50% range, and paired t-tests to determine the effect of prosthesis condition on the whole stride range (α = 0.05). FINDINGS Sagittal plane 50% range was greater for the sound compared to the impaired side stride (P = .003), with no difference in the coronal or transverse planes (P ≥ .8). Coronal plane whole stride range was lower when wearing the mock prosthesis (P = .021), with no change in the sagittal or transverse planes (P ≥ .5). INTERPRETATION Use of a prosthesis does not reduce a sagittal plane imbalance. There may be a greater risk of loss of balance in people with upper limb absence following a perturbation, particularly when it occurs during the sound side stance phase, during which whole-body angular momentum is elevated.
Collapse
Affiliation(s)
- Jenny A Kent
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA.
| | - Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA; Jesse Brown VA Medical Center, 820 S Damen Ave, Chicago, IL 60612, USA.
| |
Collapse
|
20
|
Bourque MO, Schneider KL, Calamari JE, Reddin C, Stachowiak A, Major MJ, Duncan C, Muthukrishnan R, Rosenblatt NJ. Combining physical therapy and cognitive behavioral therapy techniques to improve balance confidence and community participation in people with unilateral transtibial amputation who use lower limb prostheses: a study protocol for a randomized sham-control clinical trial. Trials 2019; 20:812. [PMID: 31888708 PMCID: PMC6937857 DOI: 10.1186/s13063-019-3929-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/22/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Low balance confidence is a prevalent yet overlooked issue among people who use lower limb prostheses (LLP) that can diminish community integration and quality of life. There is a critical need to develop rehabilitation programs that specifically target balance confidence in people who use LLP. Previous research has shown that multicomponent interventions including cognitive-behavioral therapy (CBT) techniques and exercise are feasible and effective for improving balance confidence in older adults. Therefore, a cognitive behavioral-physical therapy (CBPT) intervention was developed to target balance confidence and increase community integration in people who use LLP. METHODS/DESIGN This randomized control trial will recruit 60 people who use LLP with low balance confidence. Participants will be randomized to the CBPT intervention condition or control condition. DISCUSSION The trial is designed to test the effects of the CBPT intervention on balance confidence and functional mobility in lower limb prosthesis users by examining self-reported and objective measures of community integration and quality of life. The trial will also examine the relationship between changes in balance confidence and changes in community integration following participation in CBPT intervention. Additionally, through participant feedback, researchers will identify opportunities to improve intervention efficacy. TRIAL REGISTRATION ClinicalTrials.gov, NCT03411148. Registration date: January 26, 2018.
Collapse
Affiliation(s)
- McKenzie O. Bourque
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| | - Kristin L. Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| | - John E. Calamari
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| | - Christopher Reddin
- Captain James A Lovell Federal Health Care Center, 2450 Buckley Rd, North Chicago, IL 60064 USA
| | - Aaron Stachowiak
- Captain James A Lovell Federal Health Care Center, 2450 Buckley Rd, North Chicago, IL 60064 USA
| | - Matthew J. Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Prosthetics and Orthotics Center, 680 North Lake Shore Drive, Chicago, IL 60611 USA
- Jesse Brown VA Medical Center, 820 S Damen Ave, Chicago, IL 60612 USA
| | - Chad Duncan
- Department of Physical Medicine and Rehabilitation, Northwestern University, Prosthetics and Orthotics Center, 680 North Lake Shore Drive, Chicago, IL 60611 USA
| | | | - Noah J. Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicines’ Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| |
Collapse
|
21
|
Major MJ, McConn SM, Zavaleta JL, Stine R, Gard SA. Effects of upper limb loss and prosthesis use on proactive mechanisms of locomotor stability. J Electromyogr Kinesiol 2019; 48:145-151. [PMID: 31357112 DOI: 10.1016/j.jelekin.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/10/2019] [Accepted: 07/22/2019] [Indexed: 12/01/2022] Open
Abstract
Persons with upper limb loss (ULL) experience a high prevalence of falls, with the majority of falls occurring when walking. This issue may be related to altered arm dynamics, which play an important role in proactive mechanisms of locomotor stability. This study investigated effects of ULL and prosthesis use on proactive stability mechanisms, particularly if matching the mass and inertia of the impaired limb to the sound limb would enhance locomotor stability. Gait data were collected on adults with unilateral ULL during level walking while: (1) not wearing a prosthesis, (2) wearing their customary prosthesis, (3) wearing a mock prosthesis that matched the sound limb mass and inertia. Main and interaction effects of limb side and condition on trunk rotations, arm swing, step width, free vertical moment, and margin-of-stability were analyzed. Across conditions, arm swing, free vertical moment, and margin-of-stability were 2.27, 1.13, and 1.20 times greater, respectively, on the sound limb side than the impaired limb side. Persons with ULL display asymmetry in proactive mechanisms of locomotor stability with potentially greater medial-lateral stability on the sound limb side irrespective of prosthesis use, but heavier prostheses reduced the walking base of support. This bias may enhance fall risk on the impaired side if the prosthetic limb is used inappropriately to regain balance following a disturbance. Research is warranted to explore the consequences of this asymmetry on perturbation response.
Collapse
Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago, IL, USA; Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA.
| | - Suzanne M McConn
- Northwestern University, Department of Biomedical Engineering, Evanston, IL, USA
| | - José Luis Zavaleta
- Laboratorio de Ortesis y Prótesis, Instituto Nacional de Rehabilitación LGII, Ciudad de México, Mexico
| | | | - Steven A Gard
- Jesse Brown VA Medical Center, Chicago, IL, USA; Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
22
|
Abstract
BACKGROUND Arms are important for locomotor stability and preventing falls by controlling whole-body angular momentum, redirecting the body's center of mass, and providing support to arrest descent. Hence, upper limb loss (ULL) can increase fall risk. However, the prevalence of falls and factors that influence fall risk have not previously been reported for people with ULL. OBJECTIVE This study quantified fall prevalence in persons with ULL at or proximal to the wrist and identified clinical factors that contributed to the likelihood of falling. DESIGN This was a cross-sectional study. METHODS Factors including body and health characteristics, activity level, fall history, prosthesis use, and balance confidence were determined for persons with ULL proximal to the wrist using an online survey. Logistic regression analyses assessed the contribution of these factors to the classification of fallers (≥2 falls in previous year) and nonfallers. RESULTS A percentage (28.6%) of participants (n = 105) reported experiencing 2 or more falls in the past year. The regression model (R2 = 0.473) correctly classified 84.5% of cases and indicated that increased likelihood of falling was significantly influenced by reduced balance confidence, use of upper limb prostheses, and reduced physical capabilities. LIMITATIONS Data were collected online from a convenience sample, and fall classification was based on retrospective data. CONCLUSIONS Falls in persons with ULL are prevalent, suggesting that clinicians should use screening methods to identify at-risk individuals. Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics. Research is warranted to better understand the factors that underlie fall risk in persons with ULL and the efficacy of therapeutic interventions capable of mitigating fall risk.
Collapse
Affiliation(s)
- Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611 (USA); and Jesse Brown VA Medical Center, Chicago, Illinois
| |
Collapse
|
23
|
Kim J, Major MJ, Hafner B, Sawers A. Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower Limb Prosthesis Users: A Secondary Analysis. PM R 2019; 11:344-353. [PMID: 30195705 DOI: 10.1016/j.pmrj.2018.08.385] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND More than 50% of lower limb prosthesis (LLP) users report falling at least once a year, placing them at high risk for adverse health outcomes such as decreased mobility and diminished quality of life. Efforts to decrease falls in LLP users have traditionally focused on developing clinical tests to assess fall risk, designing prosthetic components to improve patient safety, and identifying risk factors to recognize potential fallers. Little attention has been directed toward recording, reporting, and characterizing the circumstances of falls in LLP users. Identifying the most common types of falls could help guide and prioritize clinical and research needs. OBJECTIVE To characterize the frequency and circumstances of falls reported by unilateral LLP users. DESIGN Secondary analysis of data from 2 cross-sectional studies. SETTING Outpatient clinic and research laboratory. PARTICIPANTS Ambulatory unilateral transtibial and transfemoral LLP users (N = 66). INTERVENTION None. OUTCOME A fall-type classification framework was developed based on biomechanical theory and published falls terminology. Self-reported falls and accompanying narrative descriptions of LLP users' falls in the previous 12 months were analyzed with the framework. Frequencies, estimated proportions, and estimated counts were compared across fall circumstances using 95% confidence intervals. RESULTS Thirty-eight participants (57.6%) reported 90 falls during the previous year. All reported falls were successfully categorized using the proposed framework. Most falls occurred from disruptions to the base of support, intrinsic destabilizing factors, and a diverse set of fall patterns. Walking on level terrain was the most common activity at the time of a fall. CONCLUSION This secondary analysis showed that falls remain frequent in ambulatory LLP users and that clinicians and researchers might wish to prioritize falls owing to disruptions of the base of support that occur while walking. Additional research with a larger sample is required to confirm and expand these results. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Janis Kim
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Matthew J Major
- Feinberg School of Medicine, Northwestern University and Jesse Brown VA Medical Center, Chicago, IL
| | - Brian Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, IL, IL 60612
| |
Collapse
|
24
|
Shepherd MK, Azocar AF, Major MJ, Rouse EJ. Amputee perception of prosthetic ankle stiffness during locomotion. J Neuroeng Rehabil 2018; 15:99. [PMID: 30409168 PMCID: PMC6225626 DOI: 10.1186/s12984-018-0432-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/25/2018] [Indexed: 12/02/2022] Open
Abstract
Background Prosthetic feet are spring-like, and their stiffness critically affects the wearer’s stability, comfort, and energetic cost of walking. Despite the importance of stiffness in ambulation, the prescription process often entails testing a limited number of prostheses, which may result in patients receiving a foot with suboptimal mechanics. To understand the resolution with which prostheses should be individually optimized, we sought to characterize below-knee prosthesis users’ psychophysical sensitivity to prosthesis stiffness. Methods We used a novel variable-stiffness ankle prosthesis to measure the repeatability of user-selected preferred stiffness, and implemented a psychophysical experiment to characterize the just noticeable difference of stiffness during locomotion. Results All eight subjects with below-knee amputation exhibited high repeatability in selecting their Preferred Stiffness (mean coefficient of variation: 14.2 ± 1.7%) and were able to correctly identify a 7.7 ± 1.3% change in ankle stiffness (with 75% accuracy). Conclusions This high sensitivity suggests prosthetic foot stiffness should be tuned with a high degree of precision on an individual basis. These results also highlight the need for a pairing of new robotic prescription tools and mechanical characterizations of prosthetic feet.
Collapse
Affiliation(s)
- Max K Shepherd
- Shirley Ryan AbilityLab, Room 11-1414, 355 E Erie St, Chicago, IL, 60611, USA. .,Department of Biomedical Engineering, Northwestern University, 663 Clark St, Evanston, IL, 60208, USA. .,Neurobionics Lab, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Alejandro F Azocar
- Neurobionics Lab, University of Michigan, Ann Arbor, MI, 48109, USA.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.,Robotics Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Matthew J Major
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, 710 North Lake Shore Drive, #1022, Chicago, IL, 60611, USA
| | - Elliott J Rouse
- Neurobionics Lab, University of Michigan, Ann Arbor, MI, 48109, USA.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.,Robotics Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| |
Collapse
|
25
|
Major MJ, Twiste M, Kenney LPJ, Howard D. The effects of prosthetic ankle stiffness on stability of gait in people with transtibial amputation. ACTA ACUST UNITED AC 2018; 53:839-852. [PMID: 28273321 DOI: 10.1682/jrrd.2015.08.0148] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/30/2015] [Indexed: 11/05/2022]
Abstract
The ability to control balance during walking is a critical precondition for minimizing fall risk, but this ability is compromised in persons with lower-limb absence because of reduced sensory feedback mechanisms and inability to actively modulate prosthesis mechanical function. Consequently, these individuals are at increased fall risk compared with nondisabled individuals. A number of gait parameters, including symmetry and temporal variability in step/stride characteristics, have been used as estimates of gait stability and fall risk. This study investigated the effect of prosthetic ankle rotational stiffness on gait parameters related to walking stability of transtibial prosthesis users. Five men walked with an experimental prosthesis that allowed for independent modulation of plantar flexion and dorsiflexion stiffness. Two levels of plantar flexion and dorsiflexion stiffness were tested during level, uphill, and downhill walking. The results demonstrate that low plantar flexion stiffness reduced time to foot-flat, and this was associated with increased perceived stability, while low dorsiflexion stiffness demonstrated trends in temporal-spatial parameters that are associated with improved gait stability (reduced variability and asymmetry). Prosthesis design and prescription for low rotational stiffness may enhance gait safety for transtibial prosthesis users at risk of unsteadiness and falls.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Chicago IL; and Jesse Brown Department of Veterans Affairs Medical Center, Chicago IL.,Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Martin Twiste
- Centre for Health Sciences Research, University of Salford, Salford, UK.,United National Institute for Prosthetics & Orthotics Development, University of Salford, Salford, UK
| | | | - David Howard
- Centre for Health Sciences Research, University of Salford, Salford, UK
| |
Collapse
|
26
|
Abstract
BACKGROUND Prosthetic feet are prescribed based on their mechanical function and user functional level. Subtle changes to the stiffness and hysteresis of heel, midfoot, and forefoot regions can influence the dynamics and economy of gait in prosthesis users. However, the user's choice of shoes may alter the prosthetic foot-shoe system mechanical characteristics, compromising carefully prescribed and rigorously engineered performance of feet. OBJECTIVES Observe the effects of footwear on the mechanical properties of the prosthetic foot-shoe system including commonly prescribed prosthetic feet. STUDY DESIGN Repeated-measures, Mechanical characterization. METHODS The stiffness and energy return was measured using a hydraulic-driven materials test machine across combinations of five prosthetic feet and four common shoes as well as a barefoot condition. RESULTS Heel energy return decreased by an average 4%-9% across feet in all shoes compared to barefoot, with a cushioned trainer displaying the greatest effect. Foot designs that may improve perceived stability by providing low heel stiffness and rapid foot-flat were compromised by the addition of shoes. CONCLUSION Shoes altered prosthesis mechanical characteristics in the sagittal and frontal planes, suggesting that shoe type should be controlled or reported in research comparing prostheses. Understanding of how different shoes could alter certain gait-related characteristics of prostheses may aid decisions on footwear made by clinicians and prosthesis users. Clinical relevance Shoes can alter function of the prosthetic foot-shoe system in unexpected and sometimes undesirable ways, often causing similar behavior across setups despite differences in foot design, and prescribing clinicians should carefully consider these effects on prosthesis performance.
Collapse
Affiliation(s)
- Matthew J Major
- 1 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,2 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Joel Scham
- 1 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | |
Collapse
|
27
|
Dillon MP, Major MJ, Kaluf B, Balasanov Y, Fatone S. Predict the Medicare Functional Classification Level (K-level) using the Amputee Mobility Predictor in people with unilateral transfemoral and transtibial amputation: A pilot study. Prosthet Orthot Int 2018; 42:191-197. [PMID: 28534664 DOI: 10.1177/0309364617706748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND While Amputee Mobility Predictor scores differ between Medicare Functional Classification Levels (K-level), this does not demonstrate that the Amputee Mobility Predictor can accurately predict K-level. OBJECTIVES To determine how accurately K-level could be predicted using the Amputee Mobility Predictor in combination with patient characteristics for persons with transtibial and transfemoral amputation. STUDY DESIGN Prediction. METHOD A cumulative odds ordinal logistic regression was built to determine the effect that the Amputee Mobility Predictor, in combination with patient characteristics, had on the odds of being assigned to a particular K-level in 198 people with transtibial or transfemoral amputation. RESULTS For people assigned to the K2 or K3 level by their clinician, the Amputee Mobility Predictor predicted the clinician-assigned K-level more than 80% of the time. For people assigned to the K1 or K4 level by their clinician, the prediction of clinician-assigned K-level was less accurate. The odds of being in a higher K-level improved with younger age and transfemoral amputation. CONCLUSION Ordinal logistic regression can be used to predict the odds of being assigned to a particular K-level using the Amputee Mobility Predictor and patient characteristics. This pilot study highlighted critical method design issues, such as potential predictor variables and sample size requirements for future prospective research. Clinical relevance This pilot study demonstrated that the odds of being assigned a particular K-level could be predicted using the Amputee Mobility Predictor score and patient characteristics. While the model seemed sufficiently accurate to predict clinician assignment to the K2 or K3 level, further work is needed in larger and more representative samples, particularly for people with low (K1) and high (K4) levels of mobility, to be confident in the model's predictive value prior to use in clinical practice.
Collapse
Affiliation(s)
- Michael P Dillon
- 1 National Centre for Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Matthew J Major
- 2 Northwestern University, Chicago, IL, USA.,3 Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Brian Kaluf
- 4 Ability Prosthetics & Orthotics, Inc., Greenville, SC, USA
| | | | | |
Collapse
|
28
|
Major MJ, Serba CK, Chen X, Reimold N, Ndubuisi-Obi F, Gordon KE. Proactive Locomotor Adjustments Are Specific to Perturbation Uncertainty in Below-Knee Prosthesis Users. Sci Rep 2018; 8:1863. [PMID: 29382889 PMCID: PMC5789867 DOI: 10.1038/s41598-018-20207-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022] Open
Abstract
Sensory-motor deficits associated with below-knee amputation impair reactions to external perturbations. As such, below-knee prosthesis users rely on proactive control strategies to maintain locomotor stability. However, there are trade-offs (metabolic, comfort, etc.) associated with proactive strategies. We hypothesize that because proactive control strategies are costly, prosthesis users and non-impaired participants will use a priori knowledge (timing, direction) of an impending lateral perturbation to make specific gait adaptations only when the timing of the perturbation is known and the adaptation can be temporally-limited. This hypothesis was partially supported. When the perturbation timing was predictable, only prosthesis users, and only on their impaired side, increased their lateral margin of stability during the steps immediately preceding the perturbation when perturbation direction was either unknown or known to be directed towards their impaired side. This strategy should reduce the likelihood of requiring a corrective step to maintain stability. However, neither group exhibited substantial proactive adaptations compared to baseline walking when perturbation timing was unpredictable, independent of perturbation direction knowledge. The absence of further proactive stabilization behaviors observed in prosthesis users in anticipation of a certain but temporally unpredictable perturbation may be partially responsible for impaired balance control.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, United States. .,Jesse Brown VA Medical Center, Chicago, United States.
| | - Chelsi K Serba
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, United States
| | - Xinlin Chen
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, United States
| | - Nicholas Reimold
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, United States
| | - Franklyn Ndubuisi-Obi
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, United States
| | - Keith E Gordon
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, United States.,Edward Hines, Jr. VA Hospital, Hines, United States
| |
Collapse
|
29
|
Nepomuceno A, Major MJ, Stine R, Gard S. Effect of foot and ankle immobilization on able-bodied gait as a model to increase understanding about bilateral transtibial amputee gait. Prosthet Orthot Int 2017; 41:556-563. [PMID: 28318394 DOI: 10.1177/0309364617698521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The anatomical foot-ankle complex facilitates advancement of the stance limb through foot rockers and late-stance power generation during walking, but this mechanism is altered for persons with bilateral transtibial amputation when using passive prostheses. OBJECTIVES To study the effects of bilateral foot and ankle immobilization on able-bodied gait to serve as a model for understanding gait of persons with bilateral transtibial amputation and associated compensatory mechanisms. STUDY DESIGN Comparative analysis. METHODS Nine able-bodied persons walked at self-selected slow, normal, and fast speeds. They performed trials unaltered and when fitted with bilateral foot and ankle-immobilizing casts. Data from 10 individuals with bilateral transtibial amputation walking at self-selected fast speeds were used for qualitative comparison. RESULTS The average speeds for the able-bodied fast speed cast and normal speed no-cast trials were similar and were compared with bilateral transtibial amputation data. The able-bodied cast condition data more closely matched bilateral transtibial amputation data than the no-cast data. Ankle range-of-motion and power generation at pre-swing in the cast condition were markedly decreased, while trunk lateral flexion and transverse rotation range-of-motion and peak hip power generation increased. CONCLUSION Results suggest that the absence of active ankle range-of-motion and power generation contributes to the development of characteristic compensatory gait mechanisms displayed by persons with bilateral transtibial amputation. Clinical relevance This study helps to improve understanding of compensatory mechanisms resulting from reduced foot and ankle joint motion to inform lower limb prosthesis design and function for improving gait quality of individuals with bilateral transtibial amputation.
Collapse
Affiliation(s)
- Antonia Nepomuceno
- 1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA
| | - Matthew J Major
- 2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Rebecca Stine
- 3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Steven Gard
- 1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| |
Collapse
|
30
|
Thies SB, Kenney LPJ, Sobuh M, Galpin A, Kyberd P, Stine R, Major MJ. Skill assessment in upper limb myoelectric prosthesis users: Validation of a clinically feasible method for characterising upper limb temporal and amplitude variability during the performance of functional tasks. Med Eng Phys 2017; 47:137-143. [DOI: 10.1016/j.medengphy.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/08/2017] [Accepted: 03/26/2017] [Indexed: 11/30/2022]
|
31
|
Major MJ, Fey NP. Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes. Phys Ther Rev 2017; 22:1-15. [PMID: 29170616 DOI: 10.1080/10833196.2017.1346033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.
Collapse
Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago IL, USA.,Northwestern University Prosthetics Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago IL, USA
| | - Nicholas P Fey
- University of Texas at Dallas, Departments of Bioengineering and Mechanical Engineering, Richardson TX, USA.,UT Southwestern Medical Center, Department of Physical Medicine and Rehabilitation, Dallas TX, USA
| |
Collapse
|
32
|
Major MJ, Raghavan P, Gard S. Assessing a low-cost accelerometer-based technique to estimate spatial gait parameters of lower-limb prosthesis users. Prosthet Orthot Int 2016; 40:643-8. [PMID: 25733407 DOI: 10.1177/0309364614568411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 11/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Inexpensive methods for characterizing lower-limb prosthetic gait allow clinicians to monitor gait quality. This study assessed an established method for estimating step length using a low-cost accelerometer to estimate distance walked in lower-limb prosthesis users and explore the use of subject-specific correction factors. TECHNIQUE A three-axis accelerometer was attached to participants using straps. Validity and test-retest reliability of step length was assessed in able-bodied individuals using a motion capture system. Validity of distance walked was assessed with lower-limb prosthesis users. A regression equation was developed for prosthesis users to estimate a correction factor that minimized error. DISCUSSION The system demonstrated excellent reliability and minimal mean error for both participant groups, but subject-specific correction factors did not provide substantial benefit. Estimate variability was high, suggesting the need for further refinement. Estimating distance walked and step length from low-cost accelerometers may be a valid, clinically accessible method for characterizing prosthetic gait. CLINICAL RELEVANCE The use of a low-cost accelerometer may provide valid means for estimating step length and distance walked of lower-limb prosthesis users in a clinical environment for monitoring patient outcomes.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Pooja Raghavan
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA Jesse Brown VA Medical Center, Chicago, IL, USA
| |
Collapse
|
33
|
Major MJ, Caldwell R, Fatone S. Evaluation of a Prototype Hybrid Vacuum Pump to Provide Vacuum-Assisted Suspension for Above-Knee Prostheses. J Med Device 2016; 9:0445041-445044. [PMID: 27462383 DOI: 10.1115/1.4030507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/03/2015] [Indexed: 11/08/2022] Open
Abstract
Vacuum-assisted suspension (VAS) of prosthetic sockets utilizes a pump to evacuate air from between the prosthetic liner and socket, and are available as mechanical or electric systems. This technical note describes a hybrid pump that benefits from the advantages of mechanical and electric systems, and evaluates a prototype as proof-of-concept. Cyclical bench testing of the hybrid pump mechanical system was performed using a materials testing system to assess the relationship between compression cycles and vacuum pressure. Phase 1 in vivo testing of the hybrid pump was performed by an able-bodied individual using prosthesis simulator boots walking on a treadmill, and phase 2 involved an above-knee prosthesis user walking with the hybrid pump and a commercial electric pump for comparison. Bench testing of 300 compression cycles produced a maximum vacuum of 24 in-Hg. In vivo testing demonstrated that the hybrid pump continued to pull vacuum during walking, and as opposed to the commercial electric pump, did not require reactivation of the electric system during phase 2 testing. The novelty of the hybrid pump is that while the electric system provides rapid, initial vacuum suspension, the mechanical system provides continuous air evacuation while walking to maintain suspension without reactivation of the electric system, thereby allowing battery power to be reserved for monitoring vacuum levels.
Collapse
Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| | - Ryan Caldwell
- Scheck and Siress Orthotics and Prosthetics, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| |
Collapse
|
34
|
Borrenpohl D, Kaluf B, Major MJ. Survey of U.S. Practitioners on the Validity of the Medicare Functional Classification Level System and Utility of Clinical Outcome Measures for Aiding K-Level Assignment. Arch Phys Med Rehabil 2016; 97:1053-63. [DOI: 10.1016/j.apmr.2016.02.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/04/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
|
35
|
Abstract
Physical activity benefits for disease prevention are well-established. Smartphones offer a convenient platform for community-based step count estimation to monitor and encourage physical activity. Accuracy is dependent on hardware-software platforms, creating a recurring challenge for validation, but the Apple iPhone® M7 motion co-processor provides a standardised method that helps address this issue. Validity of the M7 to record step count for level-ground, able-bodied walking at three self-selected speeds, and agreement with the StepWatchTM was assessed. Steps were measured concurrently with the iPhone® (custom application to extract step count), StepWatchTM and manual count. Agreement between iPhone® and manual/StepWatchTM count was estimated through Pearson correlation and Bland-Altman analyses. Data from 20 participants suggested that iPhone® step count correlations with manual and StepWatchTM were strong for customary (1.3 ± 0.1 m/s) and fast (1.8 ± 0.2 m/s) speeds, but weak for the slow (1.0 ± 0.1 m/s) speed. Mean absolute error (manual-iPhone®) was 21%, 8% and 4% for the slow, customary and fast speeds, respectively. The M7 accurately records step count during customary and fast walking speeds, but is prone to considerable inaccuracies at slow speeds which has important implications for certain patient groups. The iPhone® may be a suitable alternative to the StepWatchTM for only faster walking speeds.
Collapse
Affiliation(s)
- Matthew J Major
- a Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine , Northwestern University Prosthetics-Orthotics Center , Chicago , IL , USA.,b Department of Veterans Affairs , Jesse Brown VA Medical Center , Chicago , IL , USA
| | - Micah Alford
- a Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine , Northwestern University Prosthetics-Orthotics Center , Chicago , IL , USA
| |
Collapse
|
36
|
Major MJ, Caldwell R, Fatone S. Comparative Effectiveness of Electric Vacuum Pumps for Creating Suspension in Transfemoral Sockets. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/jpo.0000000000000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Major MJ, Johnson WB, Gard SA. Interrater reliability of mechanical tests for functional classification of transtibial prosthesis components distal to the socket. J Rehabil Res Dev 2015; 52:467-76. [PMID: 26360815 DOI: 10.1682/jrrd.2014.12.0300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/25/2015] [Indexed: 11/05/2022]
Abstract
Substantial evidence suggests that the design and associated mechanical function of lower-limb prostheses affects user health and mobility, supporting common standards of clinical practice for appropriate matching of prosthesis design and user needs. This matching process is dependent on accurate and reliable methods for the functional classification of prosthetic components. The American Orthotic & Prosthetic Association developed a set of tests for L-code characterization of prosthesis mechanical properties to facilitate functional classification of passive below-knee prosthetic components. The mechanical tests require use of test-specific fixtures to be installed in a materials testing machine by a test administrator. Therefore, the purpose of this study was to assess the interrater reliability of test outcomes between two administrators using the same testing facility. Ten prosthetic components (8 feet and 2 pylons) that spanned the range of commercial designs were subjected to all appropriate tests. Tests with scalar outcomes demonstrated high interrater reliability (intraclass correlation coefficient(2,1) >/= 0.935), and there was no discrepancy in observation-based outcomes between administrators, suggesting that between-administrator variability may not present a significant source of error. These results support the integration of these mechanical tests for prosthesis classification, which will help enhance objectivity and optimization of the prosthesis-patient matching process for maximizing rehabilitation outcomes.
Collapse
Affiliation(s)
- Matthew J Major
- Department of Physical Medicine and Rehabilitation, Prosthetics-Orthotics Center, Northwestern University, Chicago, IL
| | | | | |
Collapse
|
38
|
Abstract
BACKGROUND Clinical management of the patient with neuropathic foot is becoming commonplace in orthotic clinics worldwide. The presentations that can result from neuropathic foot are diverse, requiring clinicians to understand the pathomechanics of ulceration, infection, and Charcot joint arthropathy to provide effective interventions. OBJECTIVES The purpose of this clinical perspective is to provide a review of the literature regarding clinical concepts associated with orthotic management of neuropathic foot. STUDY DESIGN Literature review and clinical case study. METHODS Relevant literature were reviewed and summarized, and a clinical case study synthesizing reviewed concepts was presented. RESULTS Given the multifactorial nature of the neuropathic foot, treatments must be multifaceted and patient-specific to effectively address the underlying disease processes. While systemic issues such as peripheral arterial disease are treated by physicians, local issues such as foot deformity are managed by orthotists. Orthotic interventions commonly include custom footwear to reduce the risk of ulceration through creation of a protective environment or targeted plantar offloading. Patient and caregiver education to encourage management compliance is equally as important to ensure successful treatment. CONCLUSION Patients with neuropathic foot benefit from an interdisciplinary care approach which engages physicians, wound care practitioners, and orthotists to treat and manage systemic and local problems. Addressing this pathology through interdisciplinary care may positively affect the patient's health status while lowering associated healthcare costs through improved treatment efficacy. CLINICAL RELEVANCE The commonality of neuropathic foot and associated complications including ulceration, infection, and Charcot joint arthropathy requires that the patient care team have a fundamental understanding of these pathologies and common treatment modalities. We review orthotic treatment modalities to assist clinicians with the management of patients with neuropathic foot.
Collapse
Affiliation(s)
| | - Matthew J Major
- Jesse Brown VA Medical Center, Northwestern University, Chicago, IL, USA
| | | | - Kevin Hines
- Arise Orthotics & Prosthetics, Inc., Blaine, MN, USA
| | - Pamela Cole
- Methodist Hospital Wound Clinic, St. Louis Park, MN, USA
| |
Collapse
|
39
|
Abstract
BACKGROUND Foot-drop is a common motor impairment of chronic stroke patients, which may be addressed with an ankle foot orthosis. Although there is reasonable evidence of effectiveness for ankle foot orthoses, user compliance is sometimes poor. This study investigated a new alternative to the ankle foot orthosis, the dorsiflex sock. CASE DESCRIPTION AND METHODS The dorsiflex sock was evaluated using an A-B single case experimental design. Two community-dwelling, chronic stroke patients with foot-drop participated in this study. Measures were selected to span the International Classification of Function, Disability and Health domains and user views on the dorsiflex sock were also collected. FINDINGS AND OUTCOMES The dorsiflex sock was not effective in improving participants' walking symmetry, speed or energy expenditure. Participant 1 showed improvement in the distance he could walk in 6 min when using the dorsiflex sock, but this was in keeping with a general improvement trend over the course of this study. However, both participants viewed the dorsiflex sock positively and reported a positive effect on their walking. CONCLUSION Despite positive user perceptions, the study found no clear evidence that dorsiflex sock is effective in improving foot-drop. CLINICAL RELEVANCE Although the dorsiflex sock offers an attractive alternative to an ankle foot orthosis, the case studies found no clear evidence of its efficacy. Clinicians should view this device with caution until further research becomes available.
Collapse
Affiliation(s)
- Sarah Prenton
- School of Health Sciences, University of Salford, Salford, UK
| | | | - Glen Cooper
- School of Engineering, The Manchester Metropolitan University, Manchester, UK
| | - Matthew J Major
- Northwestern University Prosthetics and Orthotics Center, Northwestern University, Chicago, IL, USA
| |
Collapse
|
40
|
Major MJ, Stine RL, Heckathorne CW, Fatone S, Gard SA. Comparison of range-of-motion and variability in upper body movements between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks. J Neuroeng Rehabil 2014; 11:132. [PMID: 25192744 PMCID: PMC4164738 DOI: 10.1186/1743-0003-11-132] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/02/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current upper limb prostheses do not replace the active degrees-of-freedom distal to the elbow inherent to intact physiology. Limited evidence suggests that transradial prosthesis users demonstrate shoulder and trunk movements to compensate for these missing volitional degrees-of-freedom. The purpose of this study was to enhance understanding of the effects of prosthesis use on motor performance by comparing the movement quality of upper body kinematics between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks that reflect activities of daily living. Methods Upper body kinematics were collected on six able-bodied controls and seven myoelectric transradial prosthesis users during execution of goal-oriented tasks. Range-of-motion, absolute kinematic variability (standard deviation), and kinematic repeatability (adjusted coefficient-of-multiple-determination) were quantified for trunk motion in three planes, shoulder flexion/extension, shoulder ab/adduction, and elbow flexion/extension across five trials per task. Linear mixed models analysis assessed between-group differences and correlation analysis evaluated association between prosthesis experience and kinematic repeatability. Results Across tasks, prosthesis users demonstrated increased trunk motion in all three planes and shoulder abduction compared to controls (p ≤ 0.004). Absolute kinematic variability was greater for prosthesis users for all degrees-of-freedom irrespective of task, but was significant only for degrees-of-freedom that demonstrated increased range-of-motion (p ≤ 0.003). For degrees-of-freedom that did not display increased absolute variability for prosthesis users, able-bodied kinematics were characterized by significantly greater repeatability (p ≤ 0.015). Prosthesis experience had a strong positive relationship with average kinematic repeatability (r = 0.790, p = 0.034). Conclusions The use of shoulder and trunk movements by prosthesis users as compensatory motions to execute goal-oriented tasks demonstrates the flexibility and adaptability of the motor system. Increased variability in movement suggests that prosthesis users do not converge on a defined motor strategy to the same degree as able-bodied individuals. Kinematic repeatability may increase with prosthesis experience, or encourage continued device use, and future work is warranted to explore these relationships. As compensatory dynamics may be necessary to improve functionality of transradial prostheses, users may benefit from dedicated training that encourages optimization of these dynamics to facilitate execution of daily living activity, and fosters adaptable but reliable motor strategies. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-132) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611, USA.
| | | | | | | | | |
Collapse
|
41
|
Kluger D, Major MJ, Fatone S, Gard SA. The effect of trunk flexion on lower-limb kinetics of able-bodied gait. Hum Mov Sci 2014; 33:395-403. [DOI: 10.1016/j.humov.2013.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
|
42
|
Major MJ, Stine RL, Gard SA. The effects of walking speed and prosthetic ankle adapters on upper extremity dynamics and stability-related parameters in bilateral transtibial amputee gait. Gait Posture 2013; 38:858-63. [PMID: 23680427 PMCID: PMC3778081 DOI: 10.1016/j.gaitpost.2013.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 04/02/2013] [Accepted: 04/17/2013] [Indexed: 02/02/2023]
Abstract
Bilateral transtibial amputee (BTA) gait has been investigated less and is not as well understood compared to that of their unilateral counterparts. Relative to able-bodied individuals, BTAs walk with reduced self-selected speeds, increased step width, hip-hiking, and greater metabolic cost. The clinically observed upper body motions of these individuals have not been quantified, but appear substantially different from able-bodied ambulators and may impact upright balance. Therefore, the objective of this study was to characterize the upper extremity kinematics of BTAs during steady-state walking. We measured medial-lateral ground reaction forces, step width and extrapolated center-of-mass (XCoM) trajectory, and observed effects of walking speed and increased prosthetic ankle range-of-motion (ROM) on these parameters. Significantly, BTAs display greater lateral trunk flexion ROM and shoulder abduction than able-bodied individuals when walking at similar speeds, and the inclusion of prosthetic adaptors for increasing passive ankle ROM slightly reduced step width. Overall, exaggerated lateral trunk flexion ROM was invariant with step width. Results suggest that lateral trunk motion is useful for shifting the body center-of-mass laterally onto the leading stance limb while simultaneously unloading the trailing limb. However, exaggerated lateral trunk flexion may introduce an unstable scenario if the XCoM is displaced beyond the lateral base-of-support. Further studies would be useful to identify if either prostheses that assist limb advancement and/or gait training may be effective in reducing this lateral sway while still maintaining efficient ambulation.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | | |
Collapse
|
43
|
Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation. Arch Phys Med Rehabil 2013; 94:2194-202. [PMID: 23856150 DOI: 10.1016/j.apmr.2013.07.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the validity and reliability of the Berg Balance Scale (BBS) for use in people with lower-limb amputation. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Individuals (N=30; age, 54±12y; 20 men) with unilateral transtibial (n=13), unilateral transfemoral (n=14), or bilateral (n=3) lower-limb amputation of dysvascular (n=7), traumatic (n=14), infectious (n=6), or congenital (n=3) origin. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES BBS, 2-minute walk test, L test, Prosthesis Evaluation Questionnaire-Mobility Subscale, Activities-specific Balance Confidence Scale, and Frenchay Activities Index; self-reported descriptors were also collected, including frequency of prosthesis use, number of falls in 12 months before the visit, fear of falling, and daily mobility aid use. RESULTS The BBS had high interrater reliability (intraclass correlation coefficient =.945) and internal consistency (α=.827). Relations between the BBS scores and those of other outcome measures were all statistically significant (P≤.001). Significant group differences in BBS scores were observed for fear of falling (P=.008) and mobility aid use (P<.001), but not for multiple (≥2) falls in the previous 12 months (P=.381). BBS items involving reaching forward, turning 360°, tandem standing, and standing on 1 leg had relatively greater frequencies of lower scores across participants. CONCLUSIONS The BBS appears to be a valid and reliable clinical instrument for assessing balance in individuals with lower-limb amputation, but it may not be able to discriminate between individuals with greater or lesser fall risk. Limitations in prosthetic motion and control may be responsible for the challenges experienced on items of lower performance. Future studies would be useful to assess the responsiveness of the BBS to interventions aimed at improving balance in individuals with lower-limb amputation.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | | | | |
Collapse
|
44
|
Major MJ, Howard D, Jones R, Twiste M. The effects of transverse rotation angle on compression and effective lever arm of prosthetic feet during simulated stance. Prosthet Orthot Int 2012; 36:231-5. [PMID: 22389423 DOI: 10.1177/0309364611435996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Unlike sagittal plane prosthesis alignment, few studies have observed the effects of transverse plane alignment on gait and prosthesis behaviour. Changes in transverse plane rotation angle will rotate the points of loading on the prosthesis during stance and may alter its mechanical behaviour. This study observed the effects of increasing the external transverse plane rotation angle, or toe-out, on foot compression and effective lever arm of three commonly prescribed prosthetic feet. TECHNIQUE The roll-over shape of a SACH, Flex and single-axis foot was measured at four external rotation angle conditions (0°, 5°, 7° and 12° relative to neutral). Differences in foot compression between conditions were measured as average distance between roll-over shapes. DISCUSSION Increasing the transverse plane rotation angle did not affect foot compression. However, it did affect the effective lever arm, which was maximized with the 5° condition, although differences between conditions were small. CLINICAL RELEVANCE Increasing the transverse plane rotation angle of prosthetic feet by up to 12° beyond neutral has minimal effects on their mechanical behaviour in the plane of walking progression during weight-bearing.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Chicago, IL 60611, USA.
| | | | | | | |
Collapse
|
45
|
Major MJ, Kenney LPJ, Twiste M, Howard D. Stance phase mechanical characterization of transtibial prostheses distal to the socket: A review. ACTA ACUST UNITED AC 2012; 49:815-29. [DOI: 10.1682/jrrd.2011.06.0108] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
46
|
Major MJ, Twiste M, Kenney LPJ, Howard D. Amputee Independent Prosthesis Properties--a new model for description and measurement. J Biomech 2011; 44:2572-5. [PMID: 21831379 DOI: 10.1016/j.jbiomech.2011.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/22/2011] [Accepted: 07/17/2011] [Indexed: 10/17/2022]
Abstract
A model is presented for describing the Amputee Independent Prosthesis Properties (AIPP) of complete assemblies of trans-tibial prosthetic components distal to the socket. This new AIPP model includes features of both lumped parameter and roll-over models and describes prosthesis properties that are of importance in stance phase, including prosthetic foot geometry, normal stiffness, shear stiffness, and damping (energy dissipation). Methods are described for measuring the parameters of the AIPP model using a custom test-rig, commercial load-cell, and a motion capture system. Example data are presented for five pylon angles reflecting the shank angles seen in normal gait. Through the inclusion of measured AIPP in future in-vivo studies comparing different prostheses more generic information, as opposed to product specific claims, will become more widely available to inform future designs, prescription, and alignment procedures.
Collapse
Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Northwestern University, Chicago, IL 60611, USA.
| | | | | | | |
Collapse
|
47
|
Preece SJ, Kenney LPJ, Major MJ, Dias T, Lay E, Fernandes BT. Automatic identification of gait events using an instrumented sock. J Neuroeng Rehabil 2011; 8:32. [PMID: 21619570 PMCID: PMC3113322 DOI: 10.1186/1743-0003-8-32] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 05/27/2011] [Indexed: 11/25/2022] Open
Abstract
Background Textile-based transducers are an emerging technology in which piezo-resistive properties of materials are used to measure an applied strain. By incorporating these sensors into a sock, this technology offers the potential to detect critical events during the stance phase of the gait cycle. This could prove useful in several applications, such as functional electrical stimulation (FES) systems to assist gait. Methods We investigated the output of a knitted resistive strain sensor during walking and sought to determine the degree of similarity between the sensor output and the ankle angle in the sagittal plane. In addition, we investigated whether it would be possible to predict three key gait events, heel strike, heel lift and toe off, with a relatively straight-forward algorithm. This worked by predicting gait events to occur at fixed time offsets from specific peaks in the sensor signal. Results Our results showed that, for all subjects, the sensor output exhibited the same general characteristics as the ankle joint angle. However, there were large between-subjects differences in the degree of similarity between the two curves. Despite this variability, it was possible to accurately predict gait events using a simple algorithm. This algorithm displayed high levels of trial-to-trial repeatability. Conclusions This study demonstrates the potential of using textile-based transducers in future devices that provide active gait assistance.
Collapse
Affiliation(s)
- Stephen J Preece
- Centre for Health, Sport and Rehabilitation Sciences Research, Blatchford Building, University of Salford, Manchester, M6 6PU, UK.
| | | | | | | | | | | |
Collapse
|
48
|
Major MJ, Twiste M, Kenney L, Howard D. INVESTIGATING EFFECTS OF MECHANICAL PROPERTIES OF TRANS-TIBIAL PROSTHESES ON USER PERFORMANCE. J Biomech 2008. [DOI: 10.1016/s0021-9290(08)70415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
49
|
Abstract
Currently, only epidemiological injury data have been reported for the new extreme sport of aggressive inline skating, or trick skating. No studies have examined the biomechanics of this sport, which involves repetitive jumping and landing from railings, ramps, and ledges, often over 1 m in height. We present results of a pilot study that examined the effect of skater experience and lower extremity biomechanics on energy absorption ability, and observed balance strategies used during two basic tricks. In these tricks, the skater jumps onto an elevated rail and maintains balance while standing in a single position (stall) or sliding along the rail (grind). Lower extremity joint kinematics, impact force characteristics, and general movement behaviours were examined during landing and balance phases. Ten male skaters performed ten stalls and ten frontside grinds on an instrumented grind rail, capable of measuring vertical force. Vertical impact force was found to decrease with increasing skater experience in stalls (r = -0.84, P = 0.002) and grinds (r = -0.84, P = 0.009). This might imply that less-experienced skaters are (subconsciously) more concerned about maintaining balance than refining technique to minimize impact force. Similar to drop landing experiments, peak impact force decreased with increasing knee flexion during stalls (r = -0.65, P = 0.04). During stalls, skaters demonstrated classic balance maintenance strategies (ankle, hip, or multi-joint) depending on trick length. During grinds, skater centre of mass never passed over the rail base of support, suggesting the use of momentum produced from obliquely approaching the rail.
Collapse
Affiliation(s)
- Matthew J Major
- Department of Mechanical and Industrial Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | | | | | | |
Collapse
|