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Maldonado-Contreras JY, Bhakta K, Camargo J, Kunapuli P, Young AJ. User- and Speed-Independent Slope Estimation for Lower-Extremity Wearable Robots. Ann Biomed Eng 2024; 52:487-497. [PMID: 37930501 DOI: 10.1007/s10439-023-03391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Wearable robots can help users traverse unstructured slopes by providing mode-specific hip, knee, and ankle joint assistance. However, generalizing the same assistance pattern across different slopes is not optimal. Control strategies that scale assistance based on slope are expected to improve the feel of the device and improve outcome measures such as decreasing metabolic cost. Prior numerical methods for slope estimation struggled to estimate slopes at variable walking speeds or were limited to a single estimation per gait cycle. This study overcomes these limitations by developing machine-learning methods that yield continuous, user- and speed-independent slope estimators for a variety of wearable robot applications using an able-bodied wearable sensor dataset. In a leave-one-subject-out cross-validation (N = 9), four-phase XGBoost regression models were trained on static-slope (fixed-slope) data and evaluated on a novel subject's static-slope and dynamic-slope (variable-slope) data. Using all available sensors, we achieved an average error of 0.88° and 1.73° mean absolute error (MAE) on static and dynamic slopes, respectively. Ankle prosthesis, knee-ankle prosthesis, and hip exoskeleton sensor suites yielded average errors under 2° MAE on static and dynamic slopes, except for the ankle prosthesis and hip exoskeleton cases on dynamic slopes which yielded an average error of 2.2° and 3.2° MAE, respectively. We found that the thigh inertial measurement unit contributed the most to a reduction in average error. Our findings suggest that reliable slope estimators can be trained using only static-slope data regardless of the type of lower-extremity wearable robot.
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Affiliation(s)
- Jairo Y Maldonado-Contreras
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
- Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
| | - Krishan Bhakta
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jonathan Camargo
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Pratik Kunapuli
- General Robotics Automation Sensing and Perception Laboratory, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Aaron J Young
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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Manz S, Seifert D, Altenburg B, Schmalz T, Dosen S, Gonzalez-Vargas J. Using embedded prosthesis sensors for clinical gait analyses in people with lower limb amputation: A feasibility study. Clin Biomech (Bristol, Avon) 2023; 106:105988. [PMID: 37230008 DOI: 10.1016/j.clinbiomech.2023.105988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. METHODS Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. FINDINGS The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). INTERPRETATION The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.
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Affiliation(s)
- Sabina Manz
- Ottobock SE & Co. KGaA, Duderstadt, Germany; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | | | | | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Willson AM, Anderson AJ, Richburg CA, Muir BC, Czerniecki J, Steele KM, Aubin PM. Full body musculoskeletal model for simulations of gait in persons with transtibial amputation. Comput Methods Biomech Biomed Engin 2023; 26:412-423. [PMID: 35499924 PMCID: PMC9626388 DOI: 10.1080/10255842.2022.2065630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This paper describes the development, properties, and evaluation of a musculoskeletal model that reflects the anatomical and prosthetic properties of a transtibial amputee using OpenSim. Average passive prosthesis properties were used to develop CAD models of a socket, pylon, and foot to replace the lower leg. Additional degrees of freedom (DOF) were included in each joint of the prosthesis for potential use in a range of research areas, such as socket torque and socket pistoning. The ankle has three DOFs to provide further generality to the model. Seven transtibial amputee subjects were recruited for this study. 3 D motion capture, ground reaction force, and electromyographic (EMG) data were collected while participants wore their prescribed prosthesis, and then a passive prototype prosthesis instrumented with a 6-DOF load cell in series with the pylon. The model's estimates of the ankle, knee, and hip kinematics comparable to previous studies. The load cell provided an independent experimental measure of ankle joint torque, which was compared to inverse dynamics results from the model and showed a 7.7% mean absolute error. EMG data and muscle outputs from OpenSim's Static Optimization tool were qualitatively compared and showed reasonable agreement. Further improvements to the muscle characteristics or prosthesis-specific foot models may be necessary to better characterize individual amputee gait. The model is open-source and available at (https://simtk.org/projects/biartprosthesis) for other researchers to use to advance our understanding and amputee gait and assist with the development of new lower limb prostheses.
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Affiliation(s)
- Andrea M. Willson
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
| | - Anthony J. Anderson
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
| | | | - Brittney C. Muir
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
| | - Joseph Czerniecki
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA,Department of Rehabilitation Medicine, University of Washington, Seattle WA, USA
| | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA
| | - Patrick M. Aubin
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
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Frossard L, Langton C, Perevoshchikova N, Feih S, Powrie R, Barrett R, Lloyd D. Next-generation devices to diagnose residuum health of individuals suffering from limb loss: A narrative review of trends, opportunities, and challenges. J Sci Med Sport 2023:S1440-2440(23)00032-4. [PMID: 36878761 DOI: 10.1016/j.jsams.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES There is a need for diagnostic devices that can assist prosthetic care providers to better assess and maintain residuum health of individuals suffering from neuromusculoskeletal dysfunctions associated with limb loss. This paper outlines the trends, opportunities, and challenges that will facilitate the development of next-generation diagnostic devices. DESIGN Narrative literature review. METHODS Information about technologies suitable for integration into next-generation diagnostic devices was extracted from 41 references. We considered the invasiveness, comprehensiveness, and practicality of each technology subjectively. RESULTS This review highlighted a trend toward future diagnostic devices of neuromusculoskeletal dysfunctions of the residuum capable to support evidence-based patient-specific prosthetic care, patient empowerment, and the development of bionic solutions. This device should positively disrupt the organization healthcare by enabling cost-utility analyses (e.g., fee-for-device business models) and addressing healthcare gaps due to labor shortages. There are opportunities to develop wireless, wearable and noninvasive diagnostic devices integrating wireless biosensors to measure change in mechanical constraints and topography of residuum tissues during real-life conditions as well as computational modeling using medical imaging and finite element analysis (e.g., digital twin). Developing the next-generation diagnostic devices will require to overcome critical barriers associated with the design (e.g., gaps between technology readiness levels of essential parts), clinical roll-out (e.g., identification of primary users), and commercialization (e.g., limited interest from investors). CONCLUSIONS We anticipate that next-generation diagnostic devices will contribute to prosthetic care innovations that will safely increase mobility, thereby improving the quality of life of the growing global population of individuals suffering from limb loss.
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Affiliation(s)
- Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - Christian Langton
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - Nataliya Perevoshchikova
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - Stefanie Feih
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | | | - Rod Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - David Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
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Frossard L, Laux S, Geada M, Heym PP, Lechler K. Loading characteristics data applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art components during daily activities. Data Brief 2022; 41:107936. [PMID: 35242918 PMCID: PMC8859002 DOI: 10.1016/j.dib.2022.107936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
The data in this paper are related to the research article entitled “Load applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art prosthetic components” (Frossard et al. Clinical Biomechanics, 89 (2021) 105457. DOI: 10.1016/j.clinbiomech.2021.105457). This article contains the overall and individual loading characteristics applied on transfemoral press-fit osseointegrated implant generated by bone-anchored prostheses fitted with state-of-the-art components during daily activities (i.e., microprocessor-controlled Rheo Knee XC knee, energy-storing-and-returning Pro-Flex XC or LP feet (ÖSSUR, Iceland)). Confounders of the loads are presented. The load profiles are characterized by the loading patterns, loading boundaries and loading local extrema of the forces and moments applied during straight-level walking, ascending and descending ramp and stairs at self-selected comfortable pace. The confounders of the loading information as well as new insights into inter-participants variability of loading patterns, loading boundaries and loading local extrema can inform the design of subsequent cross-sectional and longitudinal studies as well as literature reviews and meta-analyzes. The loading datasets are critical to clinicians and engineers designing finite element models of osseointegrated implants (e.g., medullar and percutaneous parts) and prosthetic components, algorithms capable to recognize the loading patterns applied on a residuum during daily activities, as well as clinical trials assessing the effects of particular prosthetic care interventions. Altogether, these datasets provide promoters of prosthetic care innovations with valuable insights informing the prescription of advanced prosthetic components to the growing population of individuals suffering from lower limb loss choosing bionics solutions. Online repository contains the files: https://data.mendeley.com/datasets/gmsyv97cpc/1
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Affiliation(s)
- Laurent Frossard
- YourResearchProject Pty Ltd, Brisbane, QLD, Australia
- Griffith University, Gold Coast, QLD, Australia
- Corresponding author at: YourResearchProject Pty Ltd, Brisbane, QLD, Australia. @LaurentFrossard
| | - Stefan Laux
- APC Prosthetics Pty Ltd, Alexandria, NSW, Australia
| | - Marta Geada
- APC Prosthetics Pty Ltd, Alexandria, NSW, Australia
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Mbithi FM, Chipperfield AJ, Steer JW, Dickinson AS. Developing a control framework for self-adjusting prosthetic sockets incorporating tissue injury risk estimation and generalized predictive control. Biomed Eng Lett 2021; 12:59-73. [DOI: 10.1007/s13534-021-00211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/21/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
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Load applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art prosthetic components. Clin Biomech (Bristol, Avon) 2021; 89:105457. [PMID: 34454327 DOI: 10.1016/j.clinbiomech.2021.105457] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study presented the load profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art ÖSSUR microprocessor-controlled Rheo Knee XC and energy-storing-and-returning Pro-Flex XC or LP feet during five standardized daily activities. METHODS This cross-sectional cohort study included 13 participants fitted with a press-fit transfemoral osseointegrated implant. Loading data were directly measured with the tri-axial transducer of an iPecsLab (RTC Electronics, USA) fitted between the implant and knee unit. The loading profile was characterized by spatio-temporal gaits variables, magnitude of loading boundaries as well as onset and magnitude of loading extrema during walking, ascending and descending ramp and stairs. FINDINGS A total of 2127 steps was analysed. The cadence ranged between 36 ± 7 and 47 ± 6 strides/min. The absolute maximum force and moments applied across all activities was 1322 N, 388 N and 133 N as well as 22 Nm, 52 Nm and 88 Nm on and around the long, anteroposterior and mediolateral axes of the implant, respectively. INTERPRETATION This study provided new benchmark loading data applied by transfemoral bone-anchored prostheses fitted with selected ÖSSUR state-of-the-art components. Outcomes suggested that such prostheses can generate relevant loads at the interface with the osseointegrated implant to restore ambulation effectively. This study is a worthwhile contribution toward a systematic recording, analysis, and reporting of ecological prosthetic loading profiles as well as closing the evidence gaps between prescription and biomechanical benefits of state-of-the-art components. Hopefully, this will contribute to improve outcomes for growing number of individuals with limb loss opting for bionic solutions.
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Leestma JK, Fehr KH, Adamczyk PG. Adapting Semi-Active Prostheses to Real-World Movements: Sensing and Controlling the Dynamic Mean Ankle Moment Arm with a Variable-Stiffness Foot on Ramps and Stairs. SENSORS (BASEL, SWITZERLAND) 2021; 21:6009. [PMID: 34577219 PMCID: PMC8468528 DOI: 10.3390/s21186009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Semi-active prosthetic feet can provide adaptation in different circumstances, enabling greater function with less weight and complexity than fully powered prostheses. However, determining how to control semi-active devices is still a challenge. The dynamic mean ankle moment arm (DMAMA) provides a suitable biomechanical metric, as its simplicity matches that of a semi-active device. However, it is unknown how stiffness and locomotion modes affect DMAMA, which is necessary to create closed-loop controllers for semi-active devices. In this work, we develop a method to use only a prosthesis-embedded load sensor to measure DMAMA and classify locomotion modes, with the goal of achieving mode-dependent, closed-loop control of DMAMA using a variable-stiffness prosthesis. We study how stiffness and ground incline affect the DMAMA, and we establish the feasibility of classifying locomotion modes based exclusively on the load sensor. (2) Methods: Human subjects walked on level ground, ramps, and stairs while wearing a variable-stiffness prosthesis in low-, medium-, and high-stiffness settings. We computed DMAMA from sagittal load sensor data and prosthesis geometric measurements. We used linear mixed-effects models to determine subject-independent and subject-dependent sensitivity of DMAMA to incline and stiffness. We also used a machine learning model to classify locomotion modes using only the load sensor. (3) Results: We found a positive linear sensitivity of DMAMA to stiffness on ramps and level ground. Additionally, we found a positive linear sensitivity of DMAMA to ground slope in the low- and medium-stiffness conditions and a negative interaction effect between slope and stiffness. Considerable variability suggests that applications of DMAMA as a control input should look at the running average over several strides. To examine the efficacy of real-time DMAMA-based control systems, we used a machine learning model to classify locomotion modes using only the load sensor. The classifier achieved over 95% accuracy. (4) Conclusions: Based on these findings, DMAMA has potential for use as a closed-loop control input to adapt semi-active prostheses to different locomotion modes.
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Affiliation(s)
- Jennifer K. Leestma
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA; (K.H.F.); (P.G.A.)
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Katherine Heidi Fehr
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA; (K.H.F.); (P.G.A.)
| | - Peter G. Adamczyk
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA; (K.H.F.); (P.G.A.)
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Rajula VR, Springgate L, Haque A, Kamrunnahar M, Piazza SJ, Kaluf B. A Biomimetic Adapter for Passive Self-alignment of Prosthetic Feet. Mil Med 2021; 186:665-673. [PMID: 33499476 DOI: 10.1093/milmed/usaa230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Dynamic alignment of lower limb prostheses is subjective and time-consuming. Compensatory gait strategies caused by prosthesis misalignment can negatively affect lower limb amputees who cannot access a certified prosthetist for alignment adjustments. The objective of this study is to evaluate a novel six-degrees-of-freedom passive transtibial prosthetic adapter that self-aligns during various phases of gait. This self-aligning adapter may benefit service members and veterans stationed or living far from a clinical facility. METHODS Four transtibial amputee subjects, aged 47 to 62 (mean: 55.75) years with mean weight of 163.6 lbs and mean K-level of 3.25, walked at self-selected speeds on a 10-m level walkway. Subjects walked with the self-aligning and a size- or weight-matched control adapter, assembled to a commercially available energy-storing-and-returning foot and their own socket, with 22-mm alignment perturbations in the anterior, posterior, medial, or lateral directions. Subjects were blinded to both adapter type and misalignment. Socket moments, spatiotemporal gait parameters, and subjective socket comfort were recorded. RESULTS Preliminary results showed improvements in mean peak socket moments and step length differential with the self-aligning adapter across all alignments. Walking speed and prosthesis-side base of support showed little change in all configurations. Prosthesis-side stance duration and Functional Ambulation Profile Score increased with the self-aligning adapter in some alignments. Patient-reported socket comfort increased slightly with the self-aligning adapter across all misalignments. CONCLUSION Subjects maintained similar walking speeds and experienced greater gait symmetry and reduced sagittal plane peak moments with the self-aligning adapter when exposed to misalignments. These trends suggest a benefit to transtibial amputees from a reduction in secondary gait effects from prosthesis misalignments. Additionally, a wider range of acceptable prosthesis alignments may be possible with the self-aligning adapter. Subsequent trials are underway to evaluate the self-aligning adapter in real-world environments like walking on uneven terrains, stairs, ramps, and abrupt turns.
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Affiliation(s)
| | | | - Aman Haque
- Impulse Technology LLC., State College, PA 16803, USA
| | | | - Stephen J Piazza
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Brian Kaluf
- Ability Prosthetics & Orthotics, Mechanicsburg, PA 17050, USA
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Steer JW, Worsley PR, Browne M, Dickinson A. Key considerations for finite element modelling of the residuum-prosthetic socket interface. Prosthet Orthot Int 2021; 45:138-146. [PMID: 33176573 DOI: 10.1177/0309364620967781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 09/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Finite element modelling has long been proposed to support prosthetic socket design. However, there is minimal detail in the literature to inform practice in developing and interpreting these complex, highly nonlinear models. OBJECTIVES To identify best practice recommendations for finite element modelling of lower limb prosthetics, considering key modelling approaches and inputs. STUDY DESIGN Computational modelling. METHODS This study developed a parametric finite element model using magnetic resonance imaging data from a person with transtibial amputation. Comparative analyses were performed considering socket loading methods, socket-residuum interface parameters and soft tissue material models from the literature, to quantify their effect on the residuum's biomechanical response to a range of parameterised socket designs. RESULTS These variables had a marked impact on the finite element model's predictions for limb-socket interface pressure and soft tissue shear distribution. CONCLUSIONS All modelling decisions should be justified biomechanically and clinically. In order to represent the prosthetic loading scenario in silico, researchers should (1) consider the effects of donning and interface friction to capture the generated soft tissue shear stresses, (2) use representative stiffness hyperelastic material models for soft tissues when using strain to predict injury and (3) interrogate models comparatively, against a clinically-used control.
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Affiliation(s)
- Joshua W Steer
- Bioengineering Science Research Group, School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Peter R Worsley
- Clinical Academic Facility, School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
| | - Martin Browne
- Bioengineering Science Research Group, School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Alex Dickinson
- Bioengineering Science Research Group, School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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Häggström E, Tranberg R, Hagberg K. Implant loading during walking with and without support of a single crutch in patients with bone-anchored unilateral transfemoral amputation prostheses - Analyses using iPecs instrument. Gait Posture 2021; 83:307. [PMID: 33518362 DOI: 10.1016/j.gaitpost.2016.07.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Eva Häggström
- Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Roy Tranberg
- Sahlgrenska University Hospital, Gothenburg, Sweden
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Loading applied on osseointegrated implant by transtibial bone-anchored prostheses during daily activities: Preliminary characterization of prosthetic feet. ACTA ACUST UNITED AC 2020; 32:258-271. [PMID: 33013144 DOI: 10.1097/jpo.0000000000000280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mbithi FM, Chipperfield AJ, Steer JW, Dickinson AS. Predictive Control for an Active Prosthetic Socket informed by FEA-based Tissue Damage Risk Estimation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2073-2076. [PMID: 31946309 DOI: 10.1109/embc.2019.8857155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper presents an architecture for generalized predictive control for an active prosthetic socket system, based on a cost function performance index measure for minimization of residual limb tissue injury. Finite element analysis of a transtibial residuum model donned with a total surface bearing socket was used to provide controller training data and biomechanical rationale for deep tissue injury risk assessment, by estimating the internal deformation state of the soft tissues and the residuum-socket interface loading under a range of prosthetic loading instances. The results demonstrate the concept of this approach for interface actuation modelled as translational spring and damper systems.
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Pew C, Segal AD, Neptune RR, Klute GK. Ideal operating conditions for a variable stiffness transverse plane adapter for individuals with lower-limb amputation. J Biomech 2019; 96:109330. [DOI: 10.1016/j.jbiomech.2019.109330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
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Abstract
Vertical loading rate could be associated with residuum and whole body injuries affecting individuals fitted with transtibial prostheses. The objective of this study was to outline one out of five automated methods of extraction of vertical loading rate that stacked up the best against manual detection, which is considered the gold standard during pseudo-prosthetic gait. The load applied on the long axis of the leg of three males was recorded using a transducer fitted between a prosthetic foot and physiotherapy boot while walking on a treadmill for circa 30 min. The automated method of extraction of vertical loading rate, combining the lowest absolute average and range of 95% CI difference compared to the manual method, was deemed the most accurate and precise. The average slope of the loading rate detected manually over 150 strides was 5.56 ± 1.33 kN/s, while the other slopes ranged from 4.43 ± 0.98 kN/s to 6.52 ± 1.64 kN/s depending on the automated detection method. An original method proposed here, relying on progressive loading gradient-based automated extraction, produced the closest results (6%) to manual selection. This work contributes to continuous efforts made by providers of prosthetic and rehabilitation care to generate evidence informing reflective clinical decision-making.
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Frossard L, Leech B, Pitkin M. Inter-participant variability data in loading applied on osseointegrated implant by transtibial bone-anchored prostheses during daily activities. Data Brief 2019; 26:104510. [PMID: 31667273 PMCID: PMC6811920 DOI: 10.1016/j.dib.2019.104510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 10/31/2022] Open
Abstract
The data in this paper are related to the research article entitled "Loading applied on osseointegrated implant by transtibial bone-anchored prostheses during daily activities: Preliminary characterization of prosthetic feet" (Frossard et al., 2019: Accepted). This article contains the individual and grouped loading characteristics applied on transtibial osseointegrated implant generated while walking with bone-anchored prostheses including prosthetic feet with different index of anthropomorphicity. Inter-participant variability was presented for (A) the spatio-temporal characteristics, (B) the loading boundaries and (C) the loading local extremum during walking, ascending and descending ramp and stairs. These initial inter-participant variability benchmark datasets are critical to improve the efficacy and safety of prosthetic components for transtibial prostheses as well as the design of future automated algorithms and clinical trials. Online repository contains the files: https://doi.org/10.17632/vhc6sf7ngy.1.
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Affiliation(s)
| | - Barry Leech
- Barry Leech Prosthetics & Orthotics Pty Ltd, Southport, Australia
| | - Mark Pitkin
- Tufts University, Boston, MA, USA.,Poly-Orth International, Sharon, MA, USA
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Frossard L. Loading characteristics data applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with basic components during daily activities. Data Brief 2019; 26:104492. [PMID: 31667256 PMCID: PMC6811875 DOI: 10.1016/j.dib.2019.104492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022] Open
Abstract
The data in this paper are related to the research articles entitled “Kinetics of transfemoral amputees with osseointegrated fixation performing common activities of daily living” (Lee et al., Clinical Biomechanics, 2007.22(6). p. 665–673) and “Magnitude and variability of loading on the osseointegrated implant of transfemoral amputees during walking” (Lee et al., Med Eng Phys, 2008.30(7). p. 825–833). This article contains the overall and individual loading characteristics applied on screw-type osseointegrated implant generated by transfemoral bone-anchored prostheses fitted with basic components during daily activities at self-selected comfortable pace. Overall and individual data was presented for the (A) spatio-temporal characteristics, (B) loading patterns, (C) loading boundaries and (D) the loading local extremum during level walking, ascending and descending ramp and stairs. Inter-participant variability of these new datasets with basic components is critical to improve the efficacy and safety of prosthetic components as well as the design of future automated algorithms and clinical trials. Online repository contains the files: https://data.mendeley.com/datasets/hh8rjjh73w/1.
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Affiliation(s)
- Laurent Frossard
- Queensland University of Technology, Brisbane, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia.,University of the Sunshine Coast, Maroochydore, QLD, Australia.,YourResearchProject Pty Ltd, Brisbane, QLD, Australia
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18
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Frossard L, Leech B, Pitkin M. Automated characterization of anthropomorphicity of prosthetic feet fitted to bone-anchored transtibial prosthesis. IEEE Trans Biomed Eng 2019; 66:10.1109/TBME.2019.2904713. [PMID: 30872221 PMCID: PMC6926161 DOI: 10.1109/tbme.2019.2904713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study describes differentiating prosthetic feet designs fitted to bone-anchored transtibial prostheses based on an automated characterization of ankle stiffness profile relying on direct loading measurements. The objectives were (A) to present a process characterizing stiffness using innovative macro, meso and micro analyses, (B) to present stiffness profiles for feet with and without anthropomorphic designs, where anthropomorphicity is defined as a similarity of the moment-angle dependency in prosthetic and in the anatomical ankle, (C) to determine sensitivity of characterization. METHODS Three participants walked consecutively with two instrumented bone-anchored prostheses including their own prosthetic feet and Free-Flow foot meeting the anthropomorphicity criterion by design. Angle of dorsiflexion was extracted from video footage. Bending moment was recorded using multi-axis transducer attached to osseointegrated fixation. The automated characterization of stiffness involved a 12-step process relying on data-based criterion. RESULTS The meso analyses confirmed bilinear behavior of moment-angle curves with Index of Anthropomorphicity of -2.966±2.369 Nm/Deg and 2.681±1.089 Nm/Deg indicating a convex and concave shape of usual and Free-Flow feet without and with anthropomorphic designs, respectively. CONCLUSIONS The proposed straightforward meso analysis of the stiffness was capable to report clinical meaningful differences sensitive to feet's anthropomorphicity. Results confirmed the benefits for clinicians to rely on direct loading measurement providing individualized complementary insight into impact of components. SIGNIFICANCE This work could assist the developments of standards and guidelines for manufacturing and safe fitting of components to growing population requiring transtibial prostheses with socket or direct skeletal attachment worldwide.
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Affiliation(s)
| | - Barry Leech
- Barry Leech Prosthetics & Orthotics Pty Ltd, Southport, Australia
| | - Mark Pitkin
- Tufts University, Boston, MA, USA and Poly-Orth International, Sharon, MA, USA
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19
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Stenlund P, Kulbacka-Ortiz K, Jönsson S, Brånemark R. Loads on Transhumeral Amputees Using Osseointegrated Prostheses. Ann Biomed Eng 2019; 47:1369-1377. [DOI: 10.1007/s10439-019-02244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
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20
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Zhang X, Fiedler G, Cao Z, Liu Z. A support vector machine approach to detect trans-tibial prosthetic misalignment using 3-Dimensional ground reaction force features: A proof of concept. Technol Health Care 2019; 26:715-721. [PMID: 29991151 DOI: 10.3233/thc-181338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prosthetists conventionally evaluate alignment based on visual interpretation of patients' gait, which is convenient, but largely subjective and depends on prosthetists' experience. OBJECTIVE In this paper, we explore the feasibility of using a support vector machine (SVM) approach to automatically detect misalignment of trans-tibial prostheses through ground reaction force (GRF). METHODS Alternate classification algorithms with varying kernels and feature sets were compared to assess the suitability for detection of a representative misalignment (six degrees of ankle plantar flexion) from normal alignment. A classical feature selection algorithm, Fisher Score, was further introduced to identify valuable features and reduce the dimension of feature sets. RESULTS The SVMs achieved a detection accuracy of 96.67% at best within the same subject and 88.89%, respectively, for inter-subject. Combined horizontal and vertical components of GRF features provided the maximum detection accuracies. Propulsion peak force was identified as key variable of gait for misalignment prediction. CONCLUSIONS As a proof of concept, the results demonstrate potential in applying this approach to detect prosthetic misalignment based on gait patterns, and is a step towards future developments of tools for early prevention of misalignment in clinical.
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Affiliation(s)
- Xueyi Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Goeran Fiedler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhe Cao
- Beijing Institute of Spacecraft System Engineering, Beijing, China
| | - Zhicheng Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
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21
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Henrikson KM, Weathersby EJ, Larsen BG, Cagle JC, McLean JB, Sanders JE. An Inductive Sensing System to Measure In-Socket Residual Limb Displacements for People Using Lower-Limb Prostheses. SENSORS (BASEL, SWITZERLAND) 2018; 18:E3840. [PMID: 30423932 PMCID: PMC6263676 DOI: 10.3390/s18113840] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022]
Abstract
The objective of this research was to assess the performance of an embedded sensing system designed to measure the distance between a prosthetic socket wall and residual limb. Low-profile inductive sensors were laminated into prosthetic sockets and flexible ferromagnetic targets were created from elastomeric liners with embedded iron particles for four participants with transtibial amputation. Using insights from sensor performance testing, a novel calibration procedure was developed to quickly and accurately calibrate the multiple embedded sensors. The sensing system was evaluated through laboratory tests in which participants wore sock combinations with three distinct thicknesses and conducted a series of activities including standing, walking, and sitting. When a thicker sock was worn, the limb typically moved further away from the socket and peak-to-peak displacements decreased. However, sensors did not measure equivalent distances or displacements for a given sock combination, which provided information regarding the fit of the socket and how a sock change intervention influenced socket fit. Monitoring of limb⁻socket displacements may serve as a valuable tool for researchers and clinicians to quantitatively assess socket fit.
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Affiliation(s)
- Katrina M Henrikson
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Ethan J Weathersby
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - John C Cagle
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Jake B McLean
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
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22
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Gupta S, Lee HJ, Loh KJ, Todd MD, Reed J, Barnett AD. Noncontact Strain Monitoring of Osseointegrated Prostheses. SENSORS (BASEL, SWITZERLAND) 2018; 18:E3015. [PMID: 30205608 PMCID: PMC6164507 DOI: 10.3390/s18093015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/12/2018] [Accepted: 09/06/2018] [Indexed: 11/17/2022]
Abstract
The objective of this study was to develop a noncontact, noninvasive, imaging system for monitoring the strain and deformation states of osseointegrated prostheses. The proposed sensing methodology comprised of two parts. First, a passive thin film was designed such that its electrical permittivity increases in tandem with applied tensile loading and decreases while unloading. It was found that patterning the thin films could enhance their dielectric property's sensitivity to strain. The film can be deposited onto prosthesis surfaces as an external coating prior to implant. Second, an electrical capacitance tomography (ECT) measurement technique and reconstruction algorithm were implemented to capture strain-induced changes in the dielectric property of nanocomposite-coated prosthesis phantoms when subjected to different loading scenarios. The preliminary results showed that ECT, when coupled with strain-sensitive nanocomposites, could quantify the strain-induced changes in the dielectric property of thin film-coated prosthesis phantoms. The results suggested that ECT coupled with embedded thin films could serve as a new noncontact strain sensing method for scenarios when tethered strain sensors cannot be used or instrumented, especially in the case of osseointegrated prostheses.
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Affiliation(s)
- Sumit Gupta
- Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085, USA.
| | - Han-Joo Lee
- Material Science and Engineering Program, University of California-San Diego, La Jolla, CA 92093-0085, USA.
| | - Kenneth J Loh
- Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085, USA.
- Material Science and Engineering Program, University of California-San Diego, La Jolla, CA 92093-0085, USA.
| | - Michael D Todd
- Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085, USA.
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23
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Hashimoto H, Kobayashi T, Gao F, Kataoka M, Orendurff MS, Okuda K. The effect of transverse prosthetic alignment changes on socket reaction moments during gait in individuals with transtibial amputation. Gait Posture 2018; 65:8-14. [PMID: 30558951 DOI: 10.1016/j.gaitpost.2018.06.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/02/2018] [Accepted: 06/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Alignment affects gait of individuals with transtibial prostheses. Sagittal and coronal alignment changes of the transtibial prostheses were demonstrated to affect socket reaction moments. However, the effects of transverse alignment changes on the socket reaction moments are not known. RESEARCH QUESTION The aim of this study was to investigate the effects of transverse alignment changes on the socket reaction moments and temporal-spatial parameters of gait in transtibial prostheses. METHODS The effects of transverse prosthetic alignment changes (i.e. 10° and 5° of internal and external rotations: toe-in and toe-out of the foot relative to the socket from a baseline alignment) on the sagittal and coronal socket reaction moments and temporal-spatial parameters (gait speed, cadence and step width) while walking in 9 individuals with transtibial amputation were investigated using an instrumented prosthetic pyramid adaptor and a three-dimentional (3D) motion capture system. RESULTS The transverse alignment changes demonstrated significant effects on the socket reaction moments in the coronal plane at 5% (P = 0.04), 20% (P = 0.04) and 75% (P = 0.0001) of stance phase. No significant effects were found in the socket reaction moments in the sagittal plane and the temporal-spatial parameters. The internal and external rotations of the prosthetic feet may have opposite effect in early and mid- to late-stance potentially due to changes in the spatial position of the heel (rearfoot) and toe (forefoot) of the prosthetic foot relative to the socket. SIGNIFICANCE Transverse alignment of the transtibial prostheses should be tuned not only considering the symmetry in toe-out angles of the feet, but also considering the potential effects of transverse alignment changes that may affect the coronal socket reaction moments.
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Affiliation(s)
- Hiroshi Hashimoto
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan; Pacific Supply co. Ltd., Daito City, Osaka, Japan.
| | - Toshiki Kobayashi
- Department of Prosthetics and Orthotics, Faculty of Health Science, Hokkaido University of Science, Sapporo, Hokkaido, Japan
| | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Masataka Kataoka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan
| | - Michael S Orendurff
- Motion & Sports Performance Laboratory, Department of Pediatric Orthopedics, Lucile Packard Children's Hospital Stanford, USA
| | - Kuniharu Okuda
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan
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24
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Cagle JC, Reinhall PG, Allyn KJ, McLean J, Hinrichs P, Hafner BJ, Sanders JE. A finite element model to assess transtibial prosthetic sockets with elastomeric liners. Med Biol Eng Comput 2018; 56:1227-1240. [PMID: 29235055 PMCID: PMC5999538 DOI: 10.1007/s11517-017-1758-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022]
Abstract
People with transtibial amputation often experience skin breakdown due to the pressures and shear stresses that occur at the limb-socket interface. The purpose of this research was to create a transtibial finite element model (FEM) of a contemporary prosthesis that included complete socket geometry, two frictional interactions (limb-liner and liner-socket), and an elastomeric liner. Magnetic resonance imaging scans from three people with characteristic transtibial limb shapes (i.e., short-conical, long-conical, and cylindrical) were acquired and used to develop the models. Each model was evaluated with two loading profiles to identify locations of focused stresses during stance phase. The models identified five locations on the participants' residual limbs where peak stresses matched locations of mechanically induced skin issues they experienced in the 9 months prior to being scanned. The peak contact pressure across all simulations was 98 kPa and the maximum resultant shear stress was 50 kPa, showing reasonable agreement with interface stress measurements reported in the literature. Future research could take advantage of the developed FEM to assess the influence of changes in limb volume or liner material properties on interface stress distributions. Graphical abstract Residual limb finite element model. Left: model components. Right: interface pressures during stance phase.
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Affiliation(s)
- John C Cagle
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Per G Reinhall
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kate J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Paul Hinrichs
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
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25
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Pather S, Vertriest S, Sondergeld P, Ramis MA, Frossard L. Load characteristics following transfemoral amputation in individuals fitted with bone-anchored prostheses: a scoping review protocol. ACTA ACUST UNITED AC 2018; 16:1286-1310. [PMID: 29894396 DOI: 10.11124/jbisrir-2017-003398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
REVIEW QUESTION The main purpose of this scoping review is to characterize loading information applied on the residuum of individuals with transfemoral amputation fitted with an osseointegrated fixation for bone-anchored prostheses.The objectives of this scoping review are: i) to map the scope of loading variables, and ii) to report the range of magnitude of loads that has been directly measured using a portable kinetic recording apparatus fitted at the distal end of the residuum during rehabilitation exercises, standardized and unscripted activities of daily living, and adverse events.The specific review questions are.
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Affiliation(s)
- Shanthan Pather
- School of Chemistry, Physics and Mechanical Engineering, Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
| | - Sofie Vertriest
- Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium
| | - Peter Sondergeld
- Library, Queensland University of Technology, Brisbane, Australia
| | - Mary-Anne Ramis
- CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence
| | - Laurent Frossard
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
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26
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Koehler-McNicholas SR, Lipschutz RD, Gard SA. The biomechanical response of persons with transfemoral amputation to variations in prosthetic knee alignment during level walking. ACTA ACUST UNITED AC 2018; 53:1089-1106. [PMID: 28355034 DOI: 10.1682/jrrd.2014.12.0311] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 09/29/2015] [Indexed: 11/05/2022]
Abstract
Prosthetic alignment is an important factor in the overall fit and performance of a lower-limb prosthesis. However, the association between prosthetic alignment and control strategies used by persons with transfemoral amputation to coordinate the movement of a passive prosthetic knee is poorly understood. This study investigated the biomechanical response of persons with transfemoral amputation to systematic perturbations in knee joint alignment during a level walking task. Quantitative gait data were collected for three alignment conditions: bench alignment, 2 cm anterior knee translation (ANT), and 2 cm posterior knee translation (POST). In response to a destabilizing alignment perturbation (i.e., the ANT condition), participants significantly increased their early-stance hip extension moment, confirming that persons with transfemoral amputation rely on a hip extensor strategy to maintain knee joint stability. However, participants also decreased the rate at which they loaded their prosthesis, decreased their affected-side step length, increased their trunk flexion, and maintained their prosthesis in a more vertical posture at the time of opposite toe off. Collectively, these results suggest that persons with transfemoral amputation rely on a combination of strategies to coordinate stance-phase knee flexion. Further, comparatively few significant changes were observed in response to the POST condition, suggesting that a bias toward posterior alignment may have fewer implications in terms of stance-phase, knee joint control.
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Affiliation(s)
- Sara R Koehler-McNicholas
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL
| | - Robert D Lipschutz
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Rehabilitation Institute of Chicago, Chicago, IL
| | - Steven A Gard
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL
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27
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Dickinson A, Steer J, Worsley P. Finite element analysis of the amputated lower limb: A systematic review and recommendations. Med Eng Phys 2017; 43:1-18. [DOI: 10.1016/j.medengphy.2017.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/18/2023]
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28
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Stenlund P, Trobos M, Lausmaa J, Brånemark R, Thomsen P, Palmquist A. Effect of load on the bone around bone-anchored amputation prostheses. J Orthop Res 2017; 35:1113-1122. [PMID: 27341064 DOI: 10.1002/jor.23352] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/22/2016] [Indexed: 02/04/2023]
Abstract
Osseointegrated transfemoral amputation prostheses have proven successful as an alternative method to the conventional socket-type prostheses. The method improves prosthetic use and thus increases the demands imposed on the bone-implant system. The hypothesis of the present study was that the loads applied to the bone-anchored implant system of amputees would result in locations of high stress and strain transfer to the bone tissue and thus contribute to complications such as unfavourable bone remodeling and/or elevated inflammatory response and/or compromised sealing function at the tissue-abutment interface. In the study, site-specific loading measurements were made on amputees and used as input data in finite element analyses to predict the stress and strain distribution in the bone tissue. Furthermore, a tissue sample retrieved from a patient undergoing implant revision was characterized in order to evaluate the long-term tissue response around the abutment. Within the limit of the evaluated bone properties in the present experiments, it is concluded that the loads applied to the implant system may compromise the sealing function between the bone and the abutment, contributing to resorption of the bone in direct contact with the abutment at the most distal end. This was supported by observations in the retrieved clinical sample of bone resorption and the formation of a soft tissue lining along the abutment interface. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1113-1122, 2017.
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Affiliation(s)
- Patrik Stenlund
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jukka Lausmaa
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Chemistry, Materials and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Thomsen
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- BIOMATCELL VINN Excellence Center of Biomaterials Cell Therapy, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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29
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Koehler-McNicholas SR, Nickel EA, Medvec J, Barrons K, Mion S, Hansen AH. The influence of a hydraulic prosthetic ankle on residual limb loading during sloped walking. PLoS One 2017; 12:e0173423. [PMID: 28278172 PMCID: PMC5344385 DOI: 10.1371/journal.pone.0173423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/19/2017] [Indexed: 11/19/2022] Open
Abstract
In recent years, numerous prosthetic ankle-foot devices have been developed to address the demands of sloped walking for individuals with lower-limb amputation. The goal of this study was to compare the performance of a passive, hydraulic ankle-foot prosthesis to two related, non-hydraulic ankles based on their ability to minimize the socket reaction moments of individuals with transtibial amputation during a range of sloped walking tasks. After a two-week accommodation period, kinematic data were collected on seven subjects with a transtibial amputation walking on an instrumented treadmill set at various slopes. Overall, this study was unable to find significant differences in the torque at the distal end of the prosthetic socket between an ankle-foot prosthesis with a hydraulic range-of-motion and other related ankle-foot prosthesis designs (rigid ankle, multiaxial ankle) during the single-support phase of walking. In addition, socket comfort and perceived exertion were not significantly different for any of the ankle-foot prostheses tested in this study. These results suggest the need for further work to determine if more advanced designs (e.g., those with microprocessor control of hydraulic features, powered ankle-foot designs) can provide more biomimetic function to prosthesis users.
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Affiliation(s)
- Sara R. Koehler-McNicholas
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Eric A. Nickel
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Joseph Medvec
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Kyle Barrons
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Spencer Mion
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Andrew H. Hansen
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
- Program in Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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Dumas R, Branemark R, Frossard L. Gait Analysis of Transfemoral Amputees: Errors in Inverse Dynamics Are Substantial and Depend on Prosthetic Design. IEEE Trans Neural Syst Rehabil Eng 2016; 25:679-685. [PMID: 28113632 DOI: 10.1109/tnsre.2016.2601378] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quantitative assessments of prostheses performances rely more and more frequently on gait analysis focusing on prosthetic knee joint forces and moments computed by inverse dynamics. However, this method is prone to errors, as demonstrated in comparison with direct measurements of these forces and moments. The magnitude of errors reported in the literature seems to vary depending on prosthetic components. Therefore, the purposes of this study were (A) to quantify and compare the magnitude of errors in knee joint forces and moments obtained with inverse dynamics and direct measurements on ten participants with transfemoral amputation during walking and (B) to investigate if these errors can be characterised for different prosthetic knees. Knee joint forces and moments computed by inverse dynamics presented substantial errors, especially during the swing phase of gait. Indeed, the median errors in percentage of the moment magnitude were 4% and 26% in extension/flexion, 6% and 19% in adduction/abduction as well as 14% and 27% in internal/external rotation during stance and swing phase, respectively. Moreover, errors varied depending on the prosthetic limb fitted with mechanical or microprocessor-controlled knees. This study confirmed that inverse dynamics should be used cautiously while performing gait analysis of amputees. Alternatively, direct measurements of joint forces and moments could be relevant for mechanical characterising of components and alignments of prosthetic limbs.
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Kobayashi T, Orendurff MS, Boone DA. Dynamic alignment of transtibial prostheses through visualization of socket reaction moments. Prosthet Orthot Int 2015; 39:512-6. [PMID: 25121726 DOI: 10.1177/0309364614545421] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/01/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Dynamic alignment of transtibial prostheses is generally performed based on visual interpretation of gait without the benefit of any kinetic analysis in the clinic. The aim of this technical note was to present and discuss the possibilities of assisting dynamic alignment of transtibial prostheses through visualization of socket reaction moments. TECHNIQUE Smart Pyramid™ (currently Europa™) was used to measure the socket reaction moments under various alignment conditions from an amputee with transtibial prosthesis. The socket reaction moments were plotted to visualize the effect of alignment changes on them, and they were clinically interpreted. DISCUSSION Socket reaction moments could complement information available to prosthetists to optimize prosthetic alignment. They could be used to reduce excessive loading on sensitive areas, to improve gait stability, or to communicate the outcome of dynamic alignment with the amputees. Further research is needed to identify the contribution of kinematics and kinetics for optimal alignment. CLINICAL RELEVANCE Dynamic alignment of transtibial prostheses is currently tuned subjectively based on prosthetists' experiences and skills. Socket reaction moments may potentially provide objective information for prosthetists to align transtibial prostheses in the clinic.
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Fiedler G, Akins J, Cooper R, Munoz S, Cooper RA. Rehabilitation of People with Lower-Limb Amputations. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0068-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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