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Dunn JA, Gomez NG, Wong B, Sinclair SK, Henninger HB, Foreman KB, Bachus KN. Transhumeral prosthesis use affects upper body kinematics and kinetics. Gait Posture 2024; 112:59-66. [PMID: 38744022 DOI: 10.1016/j.gaitpost.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Transhumeral (TH) limb loss leads to loss of body mass and reduced shoulder range of motion. Despite most owning a prosthesis, prosthesis abandonment is common. The consequence of TH limb loss and prosthesis use and disuse during gait may be compensation in the upper body, contributing to back pain or injury. Understanding the impact of not wearing a TH prosthesis on upper body asymmetries and spatial-temporal aspects of gait will inform how TH prosthesis use and disuse affects the body. RESEARCH QUESTION Does TH limb loss alter upper body asymmetries and spatial-temporal parameters during gait when wearing and not wearing a prosthesis compared to able-bodied controls? METHODS Eight male TH limb loss participants and eight male control participants completed three gait trials at self-selected speeds. The TH limb loss group performed trials with and without their prosthesis. Arm swing, trunk angular displacement, trunk-pelvis moment, and spatial-temporal aspects were compared using non-parametric statistical analyses. RESULTS Both TH walking conditions showed greater arm swing in the intact limb compared to the residual (p≤0.001), resulting in increased asymmetry compared to the control group (p≤0.001). Without the prosthesis, there was less trunk flexion and lateral flexion compared to the control group (p≤0.001). Maximum moments between the trunk and pelvis were higher in the TH group than the control group (p≤0.05). Spatial-temporal parameters of gait did not differ between the control group and either TH limb loss condition. SIGNIFICANCE Prosthesis use affects upper body kinematics and kinetics, but does not significantly impact spatial-temporal aspects of gait, suggesting these are compensatory actions. Wearing a prosthesis helps achieve more normative upper body kinematics and kinetics than not wearing a prosthesis, which may help limit back pain. These findings emphasize the importance of encouraging at least passive use of prostheses for individuals with TH limb loss.
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Affiliation(s)
- Julia A Dunn
- Department of Biomedical Engineering University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA; Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicholas G Gomez
- Department of Physical Therapy and Athletic Training University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA; College of Health, Human Services & Nursing California State University, 1000 E. Victoria Street, Carson, CA 90747, USA
| | - Bob Wong
- College of Nursing University of Utah, 10 2000 E, Salt Lake City, UT 84112, USA
| | - Sarina K Sinclair
- Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Veterans Affairs, 500 Foothill Boulevard, Salt Lake City, UT 84148, USA
| | - Heath B Henninger
- Department of Biomedical Engineering University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA; Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy and Athletic Training University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Kent N Bachus
- Department of Biomedical Engineering University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA; Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Veterans Affairs, 500 Foothill Boulevard, Salt Lake City, UT 84148, USA.
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Gladish JR, Dearth CL, Beachler MD, Potter BK, Forsberg JA, Hendershot BD. Mechanical loading of bone-anchored implants during functional performance tests in service members with transfemoral limb loss. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1336115. [PMID: 38560026 PMCID: PMC10978646 DOI: 10.3389/fresc.2024.1336115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Introduction For individuals with limb loss, bone-anchored implants create a direct structural and functional connection to a terminal prosthesis. Here, we characterized the mechanical loads distal to the abutment during several functional performance tests in Service members with transfemoral (TF) limb loss, to expand on prior work evaluating more steady-state ambulation on level ground or slopes/stairs. Methods Two males with unilateral TF limb loss and two males with bilateral TF limb loss participated after two-stage osseointegration (24 and 12 months, respectively). Tri-directional forces and moments were wirelessly recorded through a sensor, fit distal to the abutment, during six functional tests: Timed Up and Go (TUG), Four Square Step Test (FSST), Six Minute Walk Test (6MWT), Edgren Side-Step Test (SST), T-Test (TTEST), and Illinois Agility Test (IAT). Additionally, participants performed a straight-line gait evaluation on a 15 m level walkway at a self-selected speed (0.93-1.24 m/s). Peak values for each component of force and moment were extracted from all six functional tests; percent differences compared each peak with respect to the corresponding mean peak in straight-line walking. Results Peak mechanical loads were largest during non-steady state components of the functional tests (e.g., side-stepping during SST or TTEST, standing up from the ground during IAT). Relative to walking, peak forces during functional tests were larger by up to 143% (anterior-posterior), 181% (medial-lateral), and 110% (axial); peak moments were larger by up to 108% (flexion-extension), 50% (ab/adduction), and 211% (internal/external rotation). Conclusions A more comprehensive understanding of the mechanical loads applied to bone-anchored implants during a variety of activities is critical to maximize implant survivability and long-term outcomes, particularly for Service members who are generally young at time of injury and return to active lifestyles.
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Affiliation(s)
- Jonathan R. Gladish
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA, United States
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Christopher L. Dearth
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA, United States
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Mark D. Beachler
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Benjamin K. Potter
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Jonathan A. Forsberg
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Brad D. Hendershot
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA, United States
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Simulated Astronaut Kinematics and Injury Risk for Piloted Lunar Landings and Launches While Standing. Ann Biomed Eng 2022; 50:1857-1871. [PMID: 35818016 DOI: 10.1007/s10439-022-03002-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/27/2022] [Indexed: 12/30/2022]
Abstract
During future lunar missions, astronauts may be required to pilot vehicles while standing, and the associated kinematic and injury response is not well understood. In this study, we used human body modeling to predict unsuited astronaut kinematics and injury risk for piloted lunar launches and landings in the standing posture. Three pulses (2-5 g; 10-150 ms rise times) were applied in 10 directions (vertical; ± 10-degree offsets) for a total of 30 simulations. Across all simulations, motion envelopes were computed to quantify displacement of the astronaut's head (max 9.0 cm forward, 7.0 cm backward, 2.1 cm upward, 7.3 cm downward, 2.4 cm lateral) and arms (max 25 cm forward, 35 cm backward, 15 cm upward, 20 cm downward, 20 cm lateral). All head, neck, lumbar, and lower extremity injury metrics were within NASA's tolerance limits, except tibia compression forces (0-1543 N upper tibia; 0-1482 N lower tibia; tolerance-1350 N) and revised tibia index (0.04-0.58 upper tibia; 0.03-0.48 lower tibia; tolerance-0.43) for the 2.7 g/150 ms pulse. Pulse magnitude and duration contributed over 80% to the injury metric values, whereas loading direction contributed less than 3%. Overall, these simulations suggest piloting a lunar lander vehicle in the standing posture presents a tibia injury risk which is potentially outside NASA's acceptance limits and warrants further investigation.
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Lalwala M, Koya B, Devane KS, Hsu FC, Yates KM, Newby NJ, Somers JT, Gayzik FS, Stitzel JD, Weaver AA. Effects of Standing, Upright Seated, vs. Reclined Seated Postures on Astronaut Injury Biomechanics for Lunar Landings. Ann Biomed Eng 2022; 51:951-965. [PMID: 36352272 DOI: 10.1007/s10439-022-03108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
Astronauts may pilot a future lunar lander in a standing or upright/reclined seated posture. This study compared kinematics and injury risk for the upright/reclined (30°; 60°) seated vs. standing postures for lunar launch/landing using human body modeling across 30 simulations. While head metrics for standing and upright seated postures were comparable to 30 cm height jumps, those of reclined postures were closer to 60 cm height jumps. Head linear acceleration for 60° reclined posture in the 5 g/10 ms pulse exceeded NASA's tolerance (10.1 g; tolerance: 10 g). Lower extremity metrics exceeding NASA's tolerance in the standing posture (revised tibia index: 0.36-0.53; tolerance: 0.43) were lowered in seated postures (0.00-0.04). Head displacement was higher in standing vs. seated (9.0 cm vs. 2.4 cm forward, 7.0 cm vs. 1.3 cm backward, 2.1 cm vs. 1.2 cm upward, 7.3 cm vs. 0.8 cm downward, 2.4 cm vs. 3.2 cm lateral). Higher arm movement was seen with seated vs. standing (40 cm vs. 25 cm forward, 60 cm vs. 15 cm upward, 30 cm vs. 20 cm downward). Pulse-nature contributed more than 40% to the injury metrics for seated postures compared to 80% in the standing posture. Seat recline angle contributed about 22% to the injury metrics in the seated posture. This study established a computational methodology to simulate the different postures of an astronaut for lunar landings and generated baseline injury risk and body kinematics data.
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Affiliation(s)
- Mitesh Lalwala
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
| | - Bharath Koya
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
| | - Karan S Devane
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, 525 Vine Street, Winston-Salem, NC, 27101, USA
| | | | | | - Jeffrey T Somers
- NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX, 77058, USA
| | - F Scott Gayzik
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA.
- Virginia Tech-Wake Forest Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 530, Winston-Salem, NC, 27101, USA.
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Wankier Z, Taylor C, Drew A, Kubiak E, Agarwal J, Sinclair S. Use of computer tomography imaging for analyzing bone remodeling around a percutaneous osseointegrated implant. J Orthop Res 2022; 40:2065-2075. [PMID: 34910325 DOI: 10.1002/jor.25247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 02/04/2023]
Abstract
Osseointegration (OI) is being used for the direct skeletal attachment of prosthetic limbs using an intramedullary stem that extends percutaneously from the subject's residual limb. For this technology to be successful, bone ingrowth and remodeling around the implant must occur. Physicians need an effective way to assess bone remodeling to make informed treatment and rehabilitation decisions. Previous studies utilizing two-dimensional imaging X-ray as a tool to monitor bone-remodeling around OI devices have limitations. This study describes methodology that was developed utilizing computed tomography (CT) imaging as a tool for analyzing bone remodeling around a percutaneous OI implant. Six transfemoral amputees implanted with a percutaneous osseointegrated prosthesis (POP) had CT scans taken of their residual femur at 6 and 52 weeks postoperatively. Three-dimensional femoral models were processed using custom MATLAB script to collect cortical and medullary morphology measurements. Morphology data from 6- and 52-week scans were compared to quantify bone remodeling around the POP implant. Fifty-two weeks after implantation of the POP device, increases in cortical bone area and thickness were observed around the porous-coated stem. Minimal changes were observed in the medullary canal parameters within the periprosthetic regions. This study successfully utilized CT imaging and three-dimensional modeling techniques to analyze longitudinal data of bone remodeling around a transfemoral percutaneous implant. These methods have the potential to be used as a clinical tool for evaluating orthopedic implants in vivo. Data collected suggests that the POP device achieved the desired bone remodeling around the porous-coated region of the implanted stem.
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Affiliation(s)
- Zakary Wankier
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Carolyn Taylor
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Alex Drew
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Erik Kubiak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopedic Surgery, University of Nevada Las Vegas, Las Vegas, Nevada, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jayant Agarwal
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Plastic Surgery, Salt Lake City, Utah, USA
| | - Sarina Sinclair
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
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