Degree of Safety Against Falls Provided by 4 Different Prosthetic Knee Types in People With Transfemoral Amputation: A Retrospective Observational Study

The effects of microprocessor prosthetic knee use in early rehabilitation: A pilot randomized controlled trial

BACKGROUND

Microprocessor-controlled prosthetic knees (MPKs) improve safety, stability, and mobility for people with transfemoral amputation. Despite these benefits, MPKs are often not used for people in early rehabilitation.

OBJECTIVE

To assess the feasibility of a study that compares MPKs and nonmicroprocessor knees (NMPKs) for people with recent transfemoral amputation and report on health outcomes after 3 months of use. Investigators hypothesized that MPK users would have better outcomes than NMPK users.

DESIGN

Pilot randomized controlled study.

SETTING

Institutional laboratory.

PARTICIPANTS

Adults with recent unilateral transfemoral amputation, deemed ready for their first prosthesis, and weighed <125 kg. Eighteen participants enrolled; 15 completed the study.

INTERVENTIONS

Participants were randomized to use a MPK or NMPK in their first prosthesis.

MAIN OUTCOME MEASURE(S)

Feasibility outcomes included recruitment, retention, and missing data. Health outcome measures included performance-based and self-reported measures of mobility, participation, step activity, and falls.

RESULTS

Eighteen of 24 planned participants enrolled in the study. Fifteen participants received a study prosthesis and completed the 3-month trial (MPK: n = 9; NMPK: n = 6). Participants with an MPK had significantly higher Prosthetic Limb Users Survey of Mobility (p = .01, Hedges' g: 1.70), Activity-specific Balance Confidence (p = .01, Hedges' g: 1.75), and Return to Normal Living Index (p = .05, Hedges' g: 0.54) scores compared to patients with NMPK. No other outcomes significantly differed between groups; effect sizes (0.47-1.75) across mobility outcomes indicated better outcomes in the MPK group.

CONCLUSIONS

Enrollment goals were limited by the COVID-19 pandemic, but all 15 participants who received a study prosthesis finished the 3-month pilot study. The MPK group generally had better 3-month outcomes than the NMPK group, but few statistically significant differences were found due to the small sample size and heterogeneity within groups. Results from this pilot study can inform and power future studies that compare MPKs and NMPKs in early rehabilitation.

FHIR-standardized data collection on the clinical rehabilitation pathway of trans-femoral amputation patients

Lower limb amputation is a medical intervention which causes motor disability and may compromise quality of life. Several factors determine patients' health outcomes, including an appropriate prosthetic provision and an effective rehabilitation program, necessitating a thorough quantitative observation through different data sources. In this context, the role of interoperability becomes essential, facilitating the reuse of real-world data through the provision of structured and easily accessible databases. This study introduces a comprehensive 10-year dataset encompassing clinical features, mobility measurements, and prosthetic knees of 1006 trans-femoral amputees during 1962 hospital stays for rehabilitation. The dataset is made available in both comma-separated values (CSV) format and HL7 Fast Healthcare Interoperability Resources (FHIR)-based representation, ensuring broad utility and compatibility for researchers and healthcare practitioners. This initiative contributes to advancing community understanding of post-amputation rehabilitation and underscores the significance of interoperability in promoting seamless data sharing for meaningful insights into healthcare outcomes.

Using mobile eye tracking to measure cognitive load through gaze behavior during walking in lower limb prosthesis users: A preliminary assessment

BACKGROUND

Lower limb amputation does not affect only physical and psychological functioning but the use of a prosthetic device can also lead to increased cognitive demands. Measuring cognitive load objectively is challenging, and therefore, most studies use questionnaires that are easy to apply but can suffer from subjective bias. Motivated by this, the present study investigated whether a mobile eye tracker can be used to objectively measure cognitive load by monitoring gaze behavior during a set of motor tasks.

METHODS

Five prosthetic users and eight able-bodied controls participated in this study. Eye tracking data and kinematics were recorded during a set of motor tasks (level ground walking, walking on uneven terrain, obstacle avoidance, stairs up and ramp down, as well as ramp up and stairs down) while the participants were asked to focus their gaze on a visual target for as long as possible. Target fixation times and increase in pupil diameters were determined and correlated to subjective ratings of cognitive load.

FINDINGS

Overall, target fixation time and pupil diameter showed strong negative and positive correlations, respectively, to the subjective rating of cognitive load in the able-bodied controls (-0.75 and 0.80, respectively). However, the individual correlation strength, and in some cases, even the sign, was different across participants. A similar trend could be observed in prosthetic users.

INTERPRETATION

The results of this study showed that a mobile eye tracker may be used to estimate cognitive load in prosthesis users during locomotor tasks. This paves the way to establish a new approach to assessing cognitive load, which is objective and yet practical and simple to administer. Nevertheless, future studies should corroborate these results by comparing them to other objective measures as well as focus on translating the proposed approach outside of a laboratory.

Prosthetic Rehabilitation After Transfemoral Amputation in a Patient With an Ipsilateral Girdlestone Hip: A Case Report

To date, there have been no reported cases of patients walking with a prosthesis after receiving an ipsilateral transfemoral amputation following the Girdlestone procedure. We administered a four-month prosthetic rehabilitation program to a 66-year-old man after his transfemoral amputation following the Girdlestone procedure. As a result, he was able to walk using the prosthesis for his daily activities. The prosthesis socket featured a quadrilateral configuration. The patient's ability to ambulate after the Girdlestone procedure was attributed to his ischial tuberosity serving as the primary load-bearing site in the transfemoral prosthesis. With appropriate prosthetic design, fabrication, and rehabilitation, patients can walk using a transfemoral prosthesis even in cases of transfemoral amputation following the Girdlestone procedure.