1
|
Ranaldi S, Naaim A, Marchis CD, Robert T, Dumas R, Conforto S, Frossard L. Walking ability of individuals fitted with transfemoral bone-anchored prostheses: A comparative study of gait parameters. Clin Rehabil 2023; 37:1670-1683. [PMID: 37350084 PMCID: PMC10580681 DOI: 10.1177/02692155231183779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE This study presents the walking abilities of participants fitted with transfemoral bone-anchored prostheses using a total of 14 gait parameters. DESIGN Two-centre retrospective cross-sectional comparative study. SETTING Research facilities equipped with tridimensional motion capture systems. PARTICIPANTS Two control arms included eight able-bodied participants arm (54 ± 9 years, 1.75 ± 0.07 m, 76 ± 7 kg) and nine participants fitted with transfemoral socket-suspended prostheses arm (59 ± 9 years, 1.73 ± 0.07 m, 80 ± 16 kg). The intervention arm included nine participants fitted with transfemoral bone-anchored prostheses arm (51 ± 13 years, 1.78 ± 0.09 m, 87.3 ± 16.1 kg). INTERVENTION Fitting of transfemoral bone-anchored prostheses. MAIN MEASURES Comparisons were performed for two spatio-temporal, three spatial and nine temporal gait parameters. RESULTS The cadence and speed of walking were 107 ± 6 steps/min and 1.23 ± 0.19 m/s for the able-bodied participants arm, 88 ± 7 steps/min and 0.87 ± 0.17 m/s for the socket-suspended prosthesis arm, and 96 ± 6 steps/min and 1.03 ± 0.17 m/s for bone-anchored prosthesis arm, respectively. Able-bodied participants and bone-anchored prosthesis arms were comparable in age, height, and body mass index as well as cadence and speed of walking, but the able-bodied participant arm showed a swing phase 31% shorter. Bone-anchored and socket-suspended prostheses arms were comparable for age, height, mass, and body mass index as well as cadence and speed of walking, but the bone-anchored prosthesis arm showed a step width and duration of double support in seconds 65% and 41% shorter, respectively. CONCLUSIONS Bone-anchored and socket-suspended prostheses restored equally well the gait parameters at a self-selected speed. This benchmark data provides new insights into the walking ability of individuals using transfemoral bionics bone-anchored prostheses.
Collapse
Affiliation(s)
- Simone Ranaldi
- BioLab³ – Engineering Department, Roma TRE University, Rome, Lazio, Italy
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, Lyon, France
| | | | - Thomas Robert
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, Lyon, France
| | - Raphael Dumas
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, Lyon, France
| | - Silvia Conforto
- BioLab³ – Engineering Department, Roma TRE University, Rome, Lazio, Italy
| | - Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Southport, QLD, Australia
- YourResearchProject, Red Hill, QLD, Australia
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Örgel M, Aschoff HH, Sedlacek L, Graulich T, Krettek C, Roth S, Ranker A. Twenty-four months of bacterial colonialization and infection rates in patients with transcutaneous osseointegrated prosthetic systems after lower limb amputation—A prospective analysis. Front Microbiol 2022; 13:1002211. [DOI: 10.3389/fmicb.2022.1002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscutaneous osseointegrated prosthesis systems (TOPS) are alternative rehabilitation methods to socket prosthetics, after limb amputation. TOPS compromise a two-step surgery: starting with the implantation of the stem which is then followed by the creation of the transcutaneous stoma through which the exoprosthesis can be connected. Immediately after surgery, this opening is permanently exposed to pathogens. This study aimed to investigate the dynamics of bacterial colonization of the stoma to analyze whether obligate bacterial colonization leads to a risk of periprosthetic infections after TOPS treatment.MethodsThis prospective study analyzed data from 66 patients (aged 26–75 years) after TOPS treatment between 2017 and 2019. Microbiological swabs from the stoma were analyzed on the first postoperative day and 3, 6, 12, and 24 months after stoma creation. Infection rates, laboratory values (CRP, leukocyte count, hemoglobin), and body temperature were recorded at these points in time. Statistical analysis was performed using SPSS 28.ResultsThe results show the formation of a stable environment dominated by Gram-positive bacteria in the stoma of TOPS patients over 24 months. Staphylococcus aureus, Staphylococcus spp., and Streptococcus spp. were the most common species found. With regard to the cohort up to the 3 months follow-up, 7.9% (five patients) developed infections surrounding the TOPS procedure. In relation to the whole cohort with loss to follow-up of 80.3% at the 24 months follow-up the infection rates increased up to 38.3%.ConclusionThe soft tissue inside and around the transcutaneous stoma is colonialized by multiple taxa and changes over time. A stable Gram-positive dominated bacterial taxa could be a protective factor for ascending periprosthetic infections and could possibly explain the relatively low infection rate in this study as well as in literature.
Collapse
|
4
|
Frossard L, Conforto S, Aszmann OC. Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:950481. [PMID: 36189016 PMCID: PMC9397676 DOI: 10.3389/fresc.2022.950481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Correspondence: Laurent Frossard
| | | | - Oskar C. Aszmann
- Bionic Laboratory of Extremity Reconstruction and Department of Plastic & Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
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.
Collapse
|
6
|
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]
|
7
|
Characterizing loads at transfemoral osseointegrated implants. Med Eng Phys 2020; 84:103-114. [PMID: 32977907 DOI: 10.1016/j.medengphy.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/10/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022]
Abstract
Establishing normative and outlying loads on transfemoral osseointegrated devices will assist development of preclinical mechanical testing strategies to inform manufacturers and government regulators. Therefore, force and moment data from osseointegrated transfemoral transcutaneous implants were collated to better understand baseline load levels. Load data were also collected from other devices including transfemoral socket prostheses, instrumented hip stems, instrumented knee devices, instrumented limb salvage femoral endoprostheses, as well as estimated loads on transfemoral prostheses using data from able-bodied subjects. These additional data were assessed for their ability to bolster the limited osseointegrated device data. Several activities of daily living were investigated to characterize normative loading. Falling events were investigated to characterize outlying loads. Results revealed that limited loading data exist for osseointegrated devices. The most often reported activity was level walking. While these normative data may inform fatigue testing, they may not fully characterize fatigue loads during all activities of daily living. Socket prosthetics and able-bodied individuals may provide supplementary data, but significance is limited by sample sizes. Falling data are sparse, and insufficient data exist for characterizing adverse loads on osseointegrated devices. Future data collection should include more activities of daily living and adverse events to better define osseointegrated device loading profiles.
Collapse
|
8
|
Beck JP, Grogan M, Bennett BT, Jeyapalina S, Agarwal J, Bartow-McKenney C, Bugayev J, Kubiak E, Sinclair S, Grice E. Analysis of the Stomal Microbiota of a Percutaneous Osseointegrated Prosthesis: A Longitudinal Prospective Cohort Study. J Orthop Res 2019; 37:2645-2654. [PMID: 31317568 DOI: 10.1002/jor.24421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/10/2019] [Indexed: 02/04/2023]
Abstract
Percutaneous osseointegrated (OI) prostheses (POPs) are used to skeletally attach artificial limbs in amputees. While any permanent percutaneous interface is at risk of becoming infected by the resident microbiota colonizing the stoma, most of these patients remain infection-free. Avoidance of infection likely depends upon a mechanically and/or biologically stable skin-to-implant interface. The ultimate question remains, "why do some stomata become infected while others do not?" The answer might be found in the dynamic bacterial communities of the patient and within the stomal site itself. This study is an appendix to the first Food and Drug Administration approved prospective early feasibility study of OI prosthetic docking, in which, 10 transfemoral amputees were implanted with a unique POP device. In this analytical, longitudinal cohort study, each patient's skin and stomal microbiota were analyzed from the initial surgery to 1 year following the second-stage surgery. During each follow-up visit, three swab samples-stomal, device thigh skin and contralateral thigh skin-were obtained. DNA was extracted, and bacterial 16S ribosomal RNA (rRNA) genes were amplified and sequenced to profile microbial communities. The stomal microbiota were distinct from the microbiota on the adjacent thigh skin and the skin of the contralateral thigh, with a significantly increased abundance of Staphylococcus aureus within the stoma. Early on stomal microbiota were characterized by high diversity and high relative abundance of obligate anaerobes. Over time, the stomal microbiota shifted and stabilized in communities of lower diversity dominated by Streptococcus, Corynebacterium, and/or Staphylococcus spp. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2645-2654, 2019.
Collapse
Affiliation(s)
- James Peter Beck
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Orthopaedic and Plastic Surgery Research Laboratory, University of Utah, DVA SLC HCS, Research 151, 500 Foothill Drive, Salt Lake City, Utah, 84148
| | - Max Grogan
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| | - Brian T Bennett
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Sujee Jeyapalina
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Jay Agarwal
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Casey Bartow-McKenney
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| | - Julia Bugayev
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| | - Erik Kubiak
- Department of Orthopaedics, University of Nevada, Las Vegas, Nevada
| | - Sarina Sinclair
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Orthopaedic and Plastic Surgery Research Laboratory, University of Utah, DVA SLC HCS, Research 151, 500 Foothill Drive, Salt Lake City, Utah, 84148
| | - Elizabeth Grice
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| |
Collapse
|
9
|
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.
Collapse
|
10
|
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] [Grants] [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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Frossard L, Leech B, Pitkin M. Inter-participant variability data in characterization of anthropomorphicity of prosthetic feet fitted to bone-anchored transtibial prosthesis. Data Brief 2019; 25:104195. [PMID: 31406899 PMCID: PMC6685672 DOI: 10.1016/j.dib.2019.104195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022] Open
Abstract
The data in this paper are related to the research article entitled “Automated characterization of anthropomorphicity of prosthetic feet fitted to bone-anchored transtibial prosthesis” (Frossard et al., 2019: DOI: 10.1109/TBME.2019.2904713). This article contains the individual angles of dorsiflexion and bending moments generated while walking with transtibial bone-anchored prostheses including prosthetic feet with different index of anthropomorphicity. Inter-participant variability were presented for the (A) position of the load cell measuring directly to the bending moments, (B) patterns of angles of dorsiflexion and bending moment as well as moment-angle curves and (C) variations of magnitude of angles of dorsiflexion as well as the raw and bodyweight-normalized bending moments between toe contact and heel off. These initial inter-participant variability benchmark datasets are critical to design future automated algorithms and clinical trials. Online repository contains the files: https://eprints.qut.edu.au/127745/1/127745.pdf.
Collapse
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
| |
Collapse
|
13
|
The Influence of Geometry of Implants for Direct Skeletal Attachment of Limb Prosthesis on Rehabilitation Program and Stress-Shielding Intensity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6067952. [PMID: 31360717 PMCID: PMC6644269 DOI: 10.1155/2019/6067952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Abstract
The purpose of the research was to evaluate the influence of selected parameters of the implants for bone anchored prostheses on possibility of conducting static load bearing exercises and stress-shielding intensity. A press-fit implant, a threaded implant, and the proposed design were compared using the finite element method. For the analyses two features were examined: diameter (19.0 – 21.0 mm) and length (75.0 – 130.0 mm). To define the possibility of conducting rehabilitation exercises the micromotion of implants while axial loading with a force up to 1000 N was examined to evaluate the changes at implant-bone interface. The stress-shielding intensity was estimated by bone mass loss over 60 months. The results suggest that, in terms of micromotion generated during rehabilitation exercises, the threaded (max. micromotion of 16.00 μm) and the proposed (max. micromotion of 45.43 μm) implants ensure low and appropriate micromotion. In the case of the press-fit solution the load values should be selected with care, as there is a risk of losing primary stabilisation. The allowed forces (that do not stimulate the organism to generate fibrous tissue) were approx. 140 N in the case of the length of 75 mm, increasing up to 560 N, while using the length of 130 mm. Moreover, obtained stress-shielding intensities suggest that the proposed implant should provide appropriate secondary stability, similar to the threaded solution, due to the low bone mass loss during long-term use (improving at the same time more bone remodelling in distal Gruen zones, by providing lower bone mass loss by approx. 13% to 20% in dependency of the length and diameter used). On this basis it can be concluded that the proposed design can be an appropriate alternative to commercially used implants.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Frossard L, Merlo G, Quincey T, Burkett B, Berg D. Development of a Procedure for the Government Provision of Bone-Anchored Prosthesis Using Osseointegration in Australia. PHARMACOECONOMICS - OPEN 2017; 1:301-314. [PMID: 29441506 PMCID: PMC5711750 DOI: 10.1007/s41669-017-0032-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Governmental organizations are facing challenges in adjusting procedures providing equitable assistance to consumers with amputation choosing newly available osseointegrated fixations for bone-anchored prostheses (BAPs) over socket-suspended prostheses. OBJECTIVES The aims of this study were to (1) present a procedure focusing on tasks, documents and costs of prosthetic care, and (2) share observed obstacles and facilitators to implementation. METHODS This research aimed at developing a governmental procedure for the provision of BAPs was designed as an action research study. A total of 18 individuals with transfemoral amputation solely funded by a Queensland State organization were considered. RESULTS The procedure, developed between January 2011 and June 2015, included seven processes involving fixed expenses during treatment and five processes regulating ongoing prosthetic care expenses. Prosthetic care required 22 h of labor, corresponding to AUD$3300 per patient, during rehabilitation. Prosthetists spend 64 and 36% of their time focusing on prosthetic care and other activities, respectively. The procedure required adjustments related to the scope of practice of prosthetists, funding of prosthetic limbs during rehabilitation, and allocation of microprocessor-controlled prosthetic knees. Approximately 41% (7) and 59% (10) of obstacles were within (e.g. streamlining systematic processes, sustaining evaluation of this complex procedure) or outside (e.g. early and consistent consultations of stakeholders, lack of a definitive rehabilitation program) governmental control, respectively, and approximately 89% (17) of the facilitators were within governmental control (e.g. adapting existing processes). CONCLUSION This study provides a working plan to stakeholders developing and implementing policies around the care of individuals choosing osseointegration for BAPs.
Collapse
Affiliation(s)
- Laurent Frossard
- Queensland University of Technology, Brisbane, QLD Australia
- University of the Sunshine Coast, Maroochydore, QLD Australia
| | - Gregory Merlo
- Queensland University of Technology, Brisbane, QLD Australia
- Australian Centre for Health Services and Innovation, Brisbane, QLD Australia
| | - Tanya Quincey
- Queensland Artificial Limb Service, Brisbane, QLD Australia
| | - Brendan Burkett
- University of the Sunshine Coast, Maroochydore, QLD Australia
| | - Debra Berg
- Queensland Artificial Limb Service, Brisbane, QLD Australia
| |
Collapse
|
17
|
|
18
|
Vertriest S, Coorevits P, Hagberg K, Brånemark R, Häggström EE, Vanderstraeten G, Frossard LA. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Loading compliance. Prosthet Orthot Int 2017; 41:393-401. [PMID: 27117014 DOI: 10.1177/0309364616640949] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Load-bearing exercises are performed by transfemoral amputees fitted with an osseointegrated implant to facilitate bone remodelling. OBJECTIVE This study presents the loading compliance comparing loads prescribed and applied on the three axes of the implant during static load-bearing exercises with a specific emphasis on axial and vectorial comparisons. STUDY DESIGN Cohort study. METHODS A total of 11 fully rehabilitated unilateral transfemoral amputees fitted with an osseointegrated implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included 'axial' and 'vectorial' comparisons corresponding to the difference between the force applied on the long axis of the implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. RESULTS The results demonstrated that axial and vectorial differences were significant in all conditions ( p < 0.05), except for the vectorial difference for the 40 kg condition ( p = 0.182). CONCLUSION The significant lack of axial compliance led to systematic underloading of the long axis of the implant. Clinical relevance This study contributes to a better understanding of the load applied on an osseointegrated implant during the static load-bearing exercises that could contribute to improve the design of apparatus to monitor loading exercises as well as clinical guidelines for the loading progression during rehabilitation.
Collapse
Affiliation(s)
- Sofie Vertriest
- 1 Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium
| | - Pascal Coorevits
- 2 Department of Public Health, Unit of Medical Informatics and Statistics, Ghent University, Ghent, Belgium
| | - Kerstin Hagberg
- 3 Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.,4 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Brånemark
- 4 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,5 Centre of Orthopaedic Osseointegration, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Elisabet Häggström
- 3 Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.,4 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Guy Vanderstraeten
- 1 Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium.,6 Department of Physical Medicine and Orthopaedic Surgery, University, Ghent, Belgium
| | - Laurent Alain Frossard
- 7 Queensland University of Technology, Brisbane, QLD, Australia.,8 University of the Sunshine Coast, Maroochydore, QLD, Australia
| |
Collapse
|
19
|
Vertriest S, Pather S, Sondergeld P, Ramis MA, Frossard L. Rehabilitation programs after the implantation of transfemoral osseointegrated fixations for bone-anchored prostheses: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:607-619. [PMID: 28267022 DOI: 10.11124/jbisrir-2016-003023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The primary objective of this scoping review is to characterize rehabilitation programs for individuals with transfemoral amputation following the implantation of screw-type or press-fit osseointegrated fixations for bone-anchored prostheses.The secondary objective of this review is to describe partial weight bearing exercises including static and dynamic exercises as well as use of walking aids in each rehabilitation program for screw-type and press-fit fixations.The third objective of this review is to compare key rehabilitation parameters for various partial weight bearing exercises (e.g. type of training prosthesis, loading time and progression, monitoring of loading, loading direction, instructions given to patients and the use of loading regulators) within each program for screw-type and press-fit fixations (intra-variability) and between programs for screw-type and press-fit fixations (inter-variability).The specific review questions are.
Collapse
Affiliation(s)
- Sofie Vertriest
- 1Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium 2Faculty of Science and Engineering, School of Mechanical, Manufacturing and Medical Engineering, Queensland University of Technology, Brisbane, Australia 3Library, Queensland University of Technology, Brisbane, Australia 4CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence, Queensland University of Technology, Brisbane, Australia 5Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia 6Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | | | | | | | | |
Collapse
|
20
|
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.
Collapse
|
21
|
Vertriest S, Coorevits P, Hagberg K, Brånemark R, Häggström E, Vanderstraeten G, Frossard L. Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: reliability of kinetic data. IEEE Trans Neural Syst Rehabil Eng 2014; 23:423-30. [PMID: 25051557 DOI: 10.1109/tnsre.2014.2337956] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an osseointegrated implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( %SEMs ). The ICCs of all variables were above 0.9 and the %SEM values ranged between 0 and 87%. This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
Collapse
|
22
|
Criterion and construct validity of prosthesis-integrated measurement of joint moment data in persons with transtibial amputation. J Appl Biomech 2014; 30:431-8. [PMID: 24603673 DOI: 10.1123/jab.2013-0309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prosthesis-integrated sensors are appealing for use in clinical settings where gait analysis equipment is unavailable, but accurate knowledge of patients' performance is desired. Data obtained from load cells (inferring joint moments) may aid clinicians in the prescription, alignment, and gait rehabilitation of persons with limb loss. The purpose of this study was to assess the accuracy of prosthesis-integrated load cells for routine use in clinical practice. Level ground walking of persons with transtibial amputation was concurrently measured with a commercially available prosthesis-integrated load cell, a 10-camera motion analysis system, and piezoelectric force plates. Ankle and knee flexion/extension moments were derived and measurement methods were compared via correlation analysis. Pearson correlation coefficients ranged from 0.661 for ankle pronation/supination moments to 0.915 for ankle flexion/extension moments (P < .001). Root mean squared errors between measurement methods were in the magnitude of 10% of the measured range and were explainable. Differences in results depicted differences between systems in definition and computation of measurement variables. They may not limit clinical use of the load cell, but should be considered when data are compared directly to conventional gait analysis data. Construct validity of the load cell (ie, ability to measure joint moments in-situ) is supported by the study results.
Collapse
|
23
|
Farrell BJ, Prilutsky BI, Kistenberg RS, Dalton JF, Pitkin M. An animal model to evaluate skin-implant-bone integration and gait with a prosthesis directly attached to the residual limb. Clin Biomech (Bristol, Avon) 2014; 29:336-49. [PMID: 24405567 PMCID: PMC3959271 DOI: 10.1016/j.clinbiomech.2013.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the number of advantages of bone-anchored prostheses, their use in patients is limited due to the lack of complete skin-implant integration. The objective of the present study was to develop an animal model that would permit both detailed investigations of gait with a bone-anchored limb prosthesis and histological analysis of the skin-implant-bone interface after physiological loading of the implant during standing and walking. METHODS Full-body mechanics of walking in two cats were recorded and analyzed before and after implantation of a percutaneous porous titanium pylon into the right tibia and attachment of a prosthesis. The rehabilitation procedures included initial limb casting, progressively increasing loading on the implant, and standing and locomotor training. Detailed histological analysis of bone and skin ingrowth into implant was performed at the end of the study. FINDINGS The two animals adopted the bone-anchored prosthesis for standing and locomotion, although loads on the prosthetic limb during walking decreased by 22% and 62%, respectively, 4months after implantation. The animals shifted body weight to the contralateral side and increased propulsion forces by the contralateral hindlimb. Histological analysis of the limb implants demonstrated bone and skin ingrowth. INTERPRETATION The developed animal model to study prosthetic gait and tissue integration with the implant demonstrated that porous titanium implants may permit bone and skin integration and prosthetic gait with a bone-anchored prosthesis. Future studies with this model will help optimize the implant and prosthesis properties.
Collapse
Affiliation(s)
- Brad J Farrell
- School of Applied Physiology, Center for Human Movement Science, Georgia Institute of Technology, Atlanta, GA, USA
| | - Boris I Prilutsky
- School of Applied Physiology, Center for Human Movement Science, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Robert S Kistenberg
- School of Applied Physiology, Center for Human Movement Science, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Mark Pitkin
- Tufts University School of Medicine, Boston, MA, USA; Poly-Orth International, Sharon, MA, USA
| |
Collapse
|
24
|
Albert MV, McCarthy C, Valentin J, Herrmann M, Kording K, Jayaraman A. Monitoring functional capability of individuals with lower limb amputations using mobile phones. PLoS One 2013; 8:e65340. [PMID: 23750254 PMCID: PMC3672103 DOI: 10.1371/journal.pone.0065340] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 04/24/2013] [Indexed: 11/25/2022] Open
Abstract
To be effective, a prescribed prosthetic device must match the functional requirements and capabilities of each patient. These capabilities are usually assessed by a clinician and reported by the Medicare K-level designation of mobility. However, it is not clear how the K-level designation objectively relates to the use of prostheses outside of a clinical environment. Here, we quantify participant activity using mobile phones and relate activity measured during real world activity to the assigned K-levels. We observe a correlation between K-level and the proportion of moderate to high activity over the course of a week. This relationship suggests that accelerometry-based technologies such as mobile phones can be used to evaluate real world activity for mobility assessment. Quantifying everyday activity promises to improve assessment of real world prosthesis use, leading to a better matching of prostheses to individuals and enabling better evaluations of future prosthetic devices.
Collapse
Affiliation(s)
- Mark V Albert
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Kobayashi T, Orendurff MS, Zhang M, Boone DA. Effect of alignment changes on sagittal and coronal socket reaction moment interactions in transtibial prostheses. J Biomech 2013; 46:1343-50. [PMID: 23499228 DOI: 10.1016/j.jbiomech.2013.01.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/22/2013] [Accepted: 01/22/2013] [Indexed: 11/16/2022]
Abstract
Alignment is important for comfortable and stable gait of lower-limb prosthesis users. The magnitude of socket reaction moments in the multiple planes acting simultaneously upon the residual limb may be related to perception of comfort in individuals using prostheses through socket interface pressures. The aim of this study was to investigate the effect of prosthetic alignment changes on sagittal and coronal socket reaction moment interactions (moment-moment curves) and to characterize the curves in 11 individuals with transtibial amputation using novel moment-moment interaction parameters measured by plotting sagittal socket reaction moments versus coronal ones under various alignment conditions. A custom instrumented prosthesis alignment component was used to measure socket reaction moments during walking. Prosthetic alignment was tuned to a nominally aligned condition by a prosthetist, and from this position, angular (3° and 6° of flexion, extension, abduction or adduction of the socket) and translational (5mm and 10mm of anterior, posterior, medial or lateral translation of the socket) alignment changes were performed in either the sagittal or the coronal plane in a randomized manner. A total of 17 alignment conditions were tested. Coronal angulation and translation alignment changes demonstrated similar consistent changes in the moment-moment curves. Sagittal alignment changes demonstrated more complex changes compared to the coronal alignment changes. Effect of sagittal angulations and translations on the moment-moment curves was different during 2nd rocker (mid-stance) with extension malalignment appearing to cause medio-lateral instability. Presentation of coronal and sagittal socket reaction moment interactions may provide useful visual information for prosthetists to understand the biomechanical effects of malalignment of transtibial prostheses.
Collapse
|
26
|
Frossard L, Cheze L, Dumas R. Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reaction vs knee reaction. Prosthet Orthot Int 2011; 35:140-9. [PMID: 21697197 DOI: 10.1177/0309364611409002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Calculation of lower limb kinetics is limited by floor-mounted force-plates. OBJECTIVES Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer). STUDY DESIGN Comparative analysis. METHODS Kinematics, ground reaction and knee reaction data were collected using a motion analysis system, two force-plates, and a multi-axial transducer mounted below the socket, respectively. RESULTS The inverse dynamics using ground reaction underestimated the peaks of hip energy generation and absorption occurring at 63% and 76% of the gait cycle (GC) by 28% and 54%, respectively. This method also overestimated by 24% a phase of negative work at the hip (37%-56% GC), and underestimated the phases of positive (57%-72% GC) and negative (73%-98%GC) work at the hip by 11% and 58%, respectively. CONCLUSIONS A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without the issue of foot placement on force-plates. CLINICAL RELEVANCE The hip is the only joint an amputee controls directly to set the prosthesis in motion. Hip joint kinetics are associated with joint degeneration, low back pain, risk of falls, etc. Therefore, realistic assessment of hip kinetics over multiple gait cycles and a wide range of activities is essential.
Collapse
Affiliation(s)
- Laurent Frossard
- Group of Research on Adapted Physical Activities, University of Quebec, Montreal, Canada.
| | | | | |
Collapse
|
27
|
Frossard L, Stevenson N, Sullivan J, Uden M, Pearcy M. Categorization of Activities of Daily Living of Lower Limb Amputees During Short-Term Use of a Portable Kinetic Recording System: A Preliminary Study. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/jpo.0b013e318207914c] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Frossard LA. Load on osseointegrated fixation of a transfemoral amputee during a fall: Determination of the time and duration of descent. Prosthet Orthot Int 2010; 34:472-87. [PMID: 20961183 DOI: 10.3109/03093646.2010.520057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mitigation of fall-related injuries for populations of transfemoral amputees fitted with a socket or an osseointegrated fixation is challenging. Wearing a protective device fitted within the prosthesis might be a possible solution, provided that issues with automated fall detection and time of deployment of the protective mechanism are solved. The first objective of this study was to give some examples of the times and durations of descent during a real forward fall of a transfemoral amputee that occurred inadvertently while attending a gait measurement session to assess the load applied on the residuum. The second objective was to present five semi-automated methods of detection of the time of descent using the load data. The load was measured directly at 200 Hz using a six-channel transducer. The average time and duration of descent were 242 ± 42 ms (145-310 ms) and 619 ± 42 ms (550-715 ms), respectively. This study demonstrated that the transition between walking and falling was characterized by times of descent that occurred sequentially. The sensitivity and specificity of an automated algorithm might be improved by combining several methods of detection based on the deviation of the loads measured from their own trends and from a template previously established.
Collapse
Affiliation(s)
- Laurent Alain Frossard
- Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
| |
Collapse
|
29
|
Frossard LA, Tranberg R, Haggstrom E, Pearcy M, Brånemark R. Load on osseointegrated fixation of a transfemoral amputee during a fall: loading, descent, impact and recovery analysis. Prosthet Orthot Int 2010; 34:85-97. [PMID: 20196690 DOI: 10.3109/03093640903585024] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Falling represents a health risk for lower limb amputees fitted with an osseointegrated fixation mainly because of the potential damage to the fixation. The purpose of this study was to characterize a real forward fall that occurred inadvertently to a transfemoral amputee fitted with an osseointegrated fixation while attending a gait measurement session to assess the load applied on the residuum. The objective was to analyze the load applied on the fixation with an emphasis on the sequence of events, the pattern and the magnitude of the forces and moments. The load was measured directly at 200 Hz using a six-channel transducer. Complementary video footage was also studied. The fall was divided into four phases: Loading (240 ms), descent (620 ms), impact (365 ms) and recovery (2495 ms). The main impact forces and moments occurred 870 ms and 915 ms after the heel contact, and corresponded to 133% BW and 17 % BWm, or 1.2 and 11.2 times the maximum forces and moments applied during the previous steps of the participant, respectively. This study provided key information to engineers and clinicians facing the challenge to design equipment, and rehabilitation and exercise programs to restore safely the locomotion of lower limb amputees.
Collapse
Affiliation(s)
- Laurent Alain Frossard
- Centre for Health Innovation and Solutions, The University of Queensland, Herston, Australia.
| | | | | | | | | |
Collapse
|
30
|
Frossard L, Gow DL, Hagberg K, Cairns N, Contoyannis B, Gray S, Brånemark R, Pearcy M. Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: a proof-of-concept study. Gait Posture 2010; 31:223-8. [PMID: 19926285 DOI: 10.1016/j.gaitpost.2009.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 10/06/2009] [Accepted: 10/20/2009] [Indexed: 02/02/2023]
Abstract
The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by four-fold anteriorly and 14-fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by nine-fold laterally and 16-fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17% and 83% of the trials, respectively, by up to + or - 10%. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs.
Collapse
Affiliation(s)
- Laurent Frossard
- School of Engineering Systems, Queensland University of Technology, Brisbane, Australia.
| | | | | | | | | | | | | | | |
Collapse
|