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Cho H, Park J, Kim B, Han K, Choi HL, Shin DW. Increased Risk of Fracture after Traumatic Amputation: A Nationwide Retrospective Cohort Study. Healthcare (Basel) 2024; 12:1362. [PMID: 38998896 PMCID: PMC11241812 DOI: 10.3390/healthcare12131362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
The physiological changes and alterations in gait following amputation may increase the risk of fractures. However, there is insufficient research on fracture risk in amputees. Therefore, this study intended to analyze whether the risk of new fractures increases after traumatic amputations. This population-based, retrospective cohort study used data from the Korean National Health Insurance System database. The study included 19,586 participants who had undergone an amputation and 76,645 matched controls. The incidence of any fracture and site-specific fractures (vertebral, hip, and others) according to amputation site(s) and severity of disability due to amputation were evaluated using Cox proportional hazard regression analysis. During the mean follow-up of 4.2 years, amputees had a higher incidence rate (IR) of any fracture (adjusted HR [aHR] 1.47, 95% CI 1.36-1.60), vertebral fracture (aHR 1.63, 95% CI 1.44-1.85), hip fracture (aHR 1.85, 95% CI 1.39-2.46), and other fracture (aHR 1.34, 95% CI 1.20-1.49) compared to that of controls. In the presence of disability, the risks were further increased and were highest among amputees with severe disabilities. All fracture risks were higher in amputees than they were in controls, regardless of lower limb or upper limb amputation. This cohort study demonstrated that traumatic amputees experienced higher incidence of all fractures than did individuals without amputations, and this risk increases with severity of disability. This finding underscores the importance of early screening and lifestyle interventions to address fracture risk in traumatic amputees.
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Affiliation(s)
- Hyeonjin Cho
- International Healthcare Center, Samsung Medical Center, Seoul 06351, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Junhee Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Bongseong Kim
- Department of Medical Statistics, Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Hea Lim Choi
- Department of Family Medicine/Executive Healthcare Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 16419, Republic of Korea
| | - Dong Wook Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 16419, Republic of Korea
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Moon SJ, Han SY, Park DH. The Effects of Proprioceptive Neuromuscular Facilitation Pattern Kinesio Taping on Arm Swing, Balance, and Gait Parameters among Chronic Stroke Patients: A Randomized Controlled Trial. Life (Basel) 2024; 14:242. [PMID: 38398751 PMCID: PMC10890237 DOI: 10.3390/life14020242] [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: 01/02/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: This study aimed to investigate the effects of proprioceptive neuromuscular facilitation pattern kinesio taping on arm swing, balance, and gait parameters among chronic stroke patients. (2) Methods: Twenty-eight participants were randomized into proprioceptive neuromuscular facilitation pattern kinesio taping during gait training (n = 14) and gait training (n = 14) groups. The proprioceptive neuromuscular facilitation pattern kinesio taping during gait training group employed proprioceptive neuromuscular facilitation pattern kinesio taping during 15 min treadmill-based gait training five times a week for four weeks, while the gait training group underwent the same gait training without proprioceptive neuromuscular facilitation pattern kinesio taping. Arm swing angle was measured using the Image J program, static balance was assessed with an AMTI force plate, dynamic balance was evaluated through the Timed Up and Go test, and gait parameters were recorded using the GAITRite system and the Dynamic Gait Index. (3) Results: After 4 weeks of training, the proprioceptive neuromuscular facilitation pattern kinesio taping during gait training group exhibited significant improvements in all variables compared to the baseline (p < 0.05), whereas the gait training group did not show statistically significant differences in any variables (p > 0.05). (4) Conclusions: This study demonstrates the effectiveness of proprioceptive neuromuscular facilitation pattern kinesio taping during gait training in enhancing arm swing angle, balance, and gait parameters.
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Affiliation(s)
| | | | - Dong-Hwan Park
- Department of Physical Therapy, Graduate School, College of Health Science, Kyungnam University, Changwon-si 51767, Republic of Korea; (S.-J.M.); (S.-Y.H.)
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Noël C, Viton JM, Bensoussan L, Cotinat M. Use of his prostheses by a double upper limb amputee 6 years after amputation: From aesthetic to functional considerations, a case report. Prosthet Orthot Int 2023:00006479-990000000-00198. [PMID: 38018990 DOI: 10.1097/pxr.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/29/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Few studies have been published on the prosthetic management of bilateral upper limb amputees. Of particular interest is to study how a patient's use of his upper limb protheses had evolved over a 6-year period in the aim to decrease their rejection rate. CASE DESCRIPTION AND METHODS Mr. D had undergone a bilateral upper limb amputation and had been fitted with 7 different prostheses in the past 6 years. Multiple validate instruments and analyses were then used to monitor the patient's fitting and choices. FINDINGS AND OUTCOMES Initially, the left prosthesis was regarded as the dominant hand and the right one as the assistive power grip hand. However, the observational results showed that wearing only a left Greifer enabled the prosthetic user to perform the same tasks as with 2 prostheses. He has gained greater satisfaction and quality of life without losing his independence. CONCLUSION The patient seemed to make a functional choice over his worrying about his physical appearance in favor of the efficiency of his prosthesis, which was essential for his everyday life, when he decided to wear only nonanthropomorphic prosthesis.
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Affiliation(s)
- Camille Noël
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France
- APHM, CHU Sainte Marguerite, Physical and Rehabilitation Medicine Department, Marseille, France
- UGECAM Institut Universitaire de Réadaptation de Valmante Sud, Marseille, France
| | - Jean-Michel Viton
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France
- APHM, CHU Sainte Marguerite, Physical and Rehabilitation Medicine Department, Marseille, France
| | - Laurent Bensoussan
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France
- APHM, CHU Sainte Marguerite, Physical and Rehabilitation Medicine Department, Marseille, France
- UGECAM Institut Universitaire de Réadaptation de Valmante Sud, Marseille, France
| | - Maëva Cotinat
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France
- APHM, CHU Sainte Marguerite, Physical and Rehabilitation Medicine Department, Marseille, France
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Promsri A. Age and Visual Contribution Effects on Postural Control Assessed by Principal Component Analysis of Kinematic Marker Data. Sports (Basel) 2023; 11:sports11050098. [PMID: 37234054 DOI: 10.3390/sports11050098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
Postural control, the ability to control the body's position in space, is considered a critical aspect of health outcomes. This current study aimed to investigate the effects of age and visual contribution on postural control. To this end, principal component analysis (PCA) was applied to extract movement components/synergies (i.e., principal movements, PMs) from kinematic marker data of bipedal balancing on stable and unstable surfaces with eyes closed and open, pooled from 17 older adults (67.8 ± 6.6 years) and 17 young adults (26.6 ± 3.3 years), one PCA-analysis for each surface condition. Then, three PCA-based variables were computed for each PM: the relative explained variance of PM-position (PP_rVAR) and of PM-acceleration (PA_rVAR) for measuring the composition of postural movements and of postural accelerations, respectively, and the root mean square of PM-acceleration (PA_RMS) for measuring the magnitude of neuromuscular control. The results show the age and visual contribution effects observed in PM1, resembling the anteroposterior ankle sway in both surface conditions. Specifically, only the greater PA1_rVAR and PA1_RMS are observed in older adults (p ≤ 0.004) and in closed-eye conditions (p < 0.001), reflecting their greater need for neuromuscular control of PM1 than in young adults and in open-eye conditions.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
- Unit of Excellence in Neuromechanics, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
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Stauffer SJ, Seth M, Pohlig RT, Beisheim-Ryan EH, Horne JR, Smith SC, Sarlo FB, Sions JM. Risk Factors for Underreporting of Life-Limiting Comorbidity Among Adults With Lower-Limb Loss. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231205083. [PMID: 37837278 PMCID: PMC10576913 DOI: 10.1177/00469580231205083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/29/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023]
Abstract
Peripheral neuropathy (PN) and peripheral arterial disease (PAD) are life-limiting comorbidities among adults with lower-limb loss that may not be adequately addressed in current care models. The objective of this study was to evaluate underreporting of PN and PAD among adults with lower-limb loss. We conducted a secondary analysis of a cross-sectional dataset of community-dwelling adults with unilateral lower-limb loss seen in an outpatient Limb Loss Clinic (n = 196; mean age = 56.7 ± 14.4 years; 73.5% male). Individuals participated in standardized clinical examinations including Semmes-Weinstein monofilament testing to assess for PN and pedal pulse palpation to assess for PAD. Bivariate regression was performed to identify key variables for subsequent stepwise logistic regression to discern risk factors. Clinical examination results indicated 16.8% (n = 33) of participants had suspected PN alone, 15.8% (n = 31) had suspected PAD alone, and 23.0% (n = 45) had suspected PN and PAD. More than half of participants with clinical examination findings of PN or PAD failed to self-report the condition (57.7% and 86.8%, respectively). Among adults with lower-limb loss with suspected PN, participants with dysvascular amputations were at lower risk of underreporting (odds ratio [OR] = 0.2, 95% CI: 0.1-0.6). For those with suspected PAD, those who reported more medication prescriptions were at lower risk of underreporting (OR = 0.8, 95% CI: 0.7-1.0). Adults with lower-limb loss underreport PN and PAD per a medical history checklist, which may indicate underdiagnosis or lack of patient awareness. Routine assessment is highly recommended in this population and may be especially critical among individuals with non-dysvascular etiology.
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Affiliation(s)
- Samantha Jeanne Stauffer
- University of Delaware, Newark, DE, USA
- Independence Prosthetics-Orthotics, Inc., Newark, DE, USA
| | - Mayank Seth
- University of Delaware, Newark, DE, USA
- Children’s Specialized Hospital, Union, NJ, USA
| | | | - Emma Haldane Beisheim-Ryan
- University of Delaware, Newark, DE, USA
- Defense Health Agency, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Sarah Carolyn Smith
- University of Delaware, Newark, DE, USA
- University of Maryland, Baltimore, MD, USA
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Sions JM, Donohoe M, Beisheim EH, Shank TM, Nichols LR. Falls and Associated Factors among Adolescents and Young Adults with Arthrogryposis Multiplex Congenita. ACTA ACUST UNITED AC 2021; 4. [PMID: 34723192 PMCID: PMC8553139 DOI: 10.23937/2643-4571/1710035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Falls research among individuals with arthrogryposis multiplex congenita (AMC), a group of congenital conditions characterized by joint contractures in two or more body regions, is sparse. The primary objectives of this study were to estimate the prevalence of single, multiple, and injurious falls among adolescents and adults with AMC and identify factors associated with multiple and injurious falls. Methods: Individuals, aged 10–50 years, with a diagnosis of AMC completed questionnaires obtaining demographic and AMC-specific information, falls history (e.g., number, injurious/non-injurious), markers of bone health, orthopedic surgical history, and mobility aid use, as well as the Gillette Functional Assessment Questionnaire and the Saltin-Grimby Physical Activity Level Scale. Falls were defined as “any body part above the ankle coming to rest on the ground, floor, or a lower level”. Falling was defined as ≥ 1 fall, while multiple falls were defined as ≥ 2 falls in the past year. Differences in falling, multiple falls, and injurious falls rates between adolescents (10–17 years) and adults (aged 18–50 years) were evaluated. Using univariate binary logistic regression models, associations between participant characteristics and multiple falls, as well as injurious falls, were evaluated, while considering age as a covariate (p ≤ 0.050); odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: Adolescents (N = 28; median age = 14 years) and adults (N = 40; median age = 32 years) with AMC had similar falling, i.e., 89.3% versus 70.0%, and injurious fall rates, i.e., 32.1% versus 27.5%, respectively (p > 0.050). Adolescents with AMC, however, were more likely to report multiple falls in the past year, i.e., 89.3%, when compared to adults with AMC, i.e., 57.5% (p = 0.005). Beyond age, multiple falls were associated with a greater number of lower-limb surgeries [p = 0.036, OR (95%CI): 1.18 (1.01–1.39)], ability to transfer floor-to-stand with support [p = 0.002, OR (95%CI): 8.98 (2.30–35.06)], and increased mobility per the Gillette Functional Assessment Questionnaire [p = 0.004, OR (95%CI): 1.48 (1.13–1.92)]. Factors associated with a reduced odds of multiple falls were spinal involvement [p = 0.025, OR (95%CI): 0.23 (0.07–0.84)], history of spinal surgery [p = 0.018, OR (95%CI: 0.18 (0.04–0.74)], greater upper extremity involvement [OR (95%CI): 0.65 (0.44–0.95)], home assistive device use [p = 0.010, OR (95%CI): 0.15 (0.03–0.63)], and community wheelchair use [p = 0.006, OR (95%CI): 0.16 (0.04–0.59)]. None of the explored characteristics were associated with injurious falls in the past year (p > 0.050). Conclusion: Falls are exceedingly common among adolescents and adults with AMC; potential risk and protective factors for multiple falls are identified for future prospective falls research.
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Affiliation(s)
| | - Maureen Donohoe
- Department of Therapeutic and Rehabilitative Services, Nemours Alfred I. DuPont Hospital for Children, USA
| | | | | | - Louise Reid Nichols
- Department of Orthopedics, Nemours Alfred I. DuPont Hospital for Children, USA
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Kent JA, Major MJ. Asymmetry of mass and motion affects the regulation of whole-body angular momentum in individuals with upper limb absence. Clin Biomech (Bristol, Avon) 2020; 76:105015. [PMID: 32361516 DOI: 10.1016/j.clinbiomech.2020.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a high fall prevalence in individuals with upper limb absence, which may be related to a momentum imbalance resulting from the loss of all or part of one arm. The purpose of this study was to characterise whole-body angular momentum in individuals with upper limb absence during walking, and determine the effect of restoring the mass and inertial properties of the impaired side with a mock prosthesis. METHODS Ten individuals with unilateral upper limb absence walked at self-selected speeds, with and without a mock prosthesis. For each condition, whole-body angular momentum range was computed during ten strides; in the first 50% of the stride bilaterally, and over the whole stride. Two-way repeated measures ANOVAs were used to assess the main effect of side and the interaction effect with prosthesis condition on the 50% range, and paired t-tests to determine the effect of prosthesis condition on the whole stride range (α = 0.05). FINDINGS Sagittal plane 50% range was greater for the sound compared to the impaired side stride (P = .003), with no difference in the coronal or transverse planes (P ≥ .8). Coronal plane whole stride range was lower when wearing the mock prosthesis (P = .021), with no change in the sagittal or transverse planes (P ≥ .5). INTERPRETATION Use of a prosthesis does not reduce a sagittal plane imbalance. There may be a greater risk of loss of balance in people with upper limb absence following a perturbation, particularly when it occurs during the sound side stance phase, during which whole-body angular momentum is elevated.
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Affiliation(s)
- Jenny A Kent
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA.
| | - Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA; Jesse Brown VA Medical Center, 820 S Damen Ave, Chicago, IL 60612, USA.
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Effects of Upper Limb Loss or Absence and Prosthesis Use on Postural Control of Standing Balance. Am J Phys Med Rehabil 2019; 99:366-371. [PMID: 31688013 DOI: 10.1097/phm.0000000000001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Persons with upper limb loss or absence experience a high prevalence of falls. Although upper limb prostheses help perform upper limb tasks, fall likelihood increases by six times with prosthesis use. The effects of upper limb loss or absence and prosthesis use on postural control are poorly documented. DESIGN Static posturography characterized postural control of standing balance between persons with unilateral upper limb loss or absence not wearing a prosthesis and wearing either a customary prosthesis or prosthesis that matched the mass, inertia, and length of their sound limb. Able-bodied controls were also compared to persons with unilateral upper limb loss or absence not wearing a prosthesis. Center-of-pressure anterior-posterior range, medial-lateral range, and sway area, as well as weight-bearing symmetry, were measured. RESULTS Persons with upper limb loss or absence display greater standing postural sway than controls. Although wearing a prosthesis improved weight-bearing symmetry, this condition increased postural sway, which was pronounced in the medial-lateral direction. CONCLUSIONS The presence of upper limb loss or absence increased postural control demands than able-bodied individuals as reflected in greater postural sway, which was further exacerbated with the use of prosthesis. Results suggest that upper limb loss or absence and prosthesis use may affect the internal models that guide motor commands to maintain body center-of-mass position equilibrium. The relatively greater postural control demands might help explain the increase fall prevalence in this patient group.
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Major MJ, McConn SM, Zavaleta JL, Stine R, Gard SA. Effects of upper limb loss and prosthesis use on proactive mechanisms of locomotor stability. J Electromyogr Kinesiol 2019; 48:145-151. [PMID: 31357112 DOI: 10.1016/j.jelekin.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/10/2019] [Accepted: 07/22/2019] [Indexed: 12/01/2022] Open
Abstract
Persons with upper limb loss (ULL) experience a high prevalence of falls, with the majority of falls occurring when walking. This issue may be related to altered arm dynamics, which play an important role in proactive mechanisms of locomotor stability. This study investigated effects of ULL and prosthesis use on proactive stability mechanisms, particularly if matching the mass and inertia of the impaired limb to the sound limb would enhance locomotor stability. Gait data were collected on adults with unilateral ULL during level walking while: (1) not wearing a prosthesis, (2) wearing their customary prosthesis, (3) wearing a mock prosthesis that matched the sound limb mass and inertia. Main and interaction effects of limb side and condition on trunk rotations, arm swing, step width, free vertical moment, and margin-of-stability were analyzed. Across conditions, arm swing, free vertical moment, and margin-of-stability were 2.27, 1.13, and 1.20 times greater, respectively, on the sound limb side than the impaired limb side. Persons with ULL display asymmetry in proactive mechanisms of locomotor stability with potentially greater medial-lateral stability on the sound limb side irrespective of prosthesis use, but heavier prostheses reduced the walking base of support. This bias may enhance fall risk on the impaired side if the prosthetic limb is used inappropriately to regain balance following a disturbance. Research is warranted to explore the consequences of this asymmetry on perturbation response.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago, IL, USA; Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA.
| | - Suzanne M McConn
- Northwestern University, Department of Biomedical Engineering, Evanston, IL, USA
| | - José Luis Zavaleta
- Laboratorio de Ortesis y Prótesis, Instituto Nacional de Rehabilitación LGII, Ciudad de México, Mexico
| | | | - Steven A Gard
- Jesse Brown VA Medical Center, Chicago, IL, USA; Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA
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