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Livolsi C, Sanz-Morere CB, Pergolini A, Giffone A, Giovacchini F, Frioriksson P, Alexandersson A, Macchi C, Trigili E, Crea S, Vitiello N. Enhancing Walking Performance With a Bilateral Hip Exoskeleton Assistance in Individuals With Above-Knee Amputation. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2553-2563. [PMID: 38980789 DOI: 10.1109/tnsre.2024.3425436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Transfemoral amputation is a debilitating condition that leads to long-term mobility restriction and secondary disorders that negatively affect the quality of life of millions of individuals worldwide. Currently available prostheses are not able to restore energetically efficient and functional gait, thus, recently, the alternative strategy to inject energy at the residual hip has been proposed to compensate for the lack of energy of the missing leg. Here, we show that a portable and powered hip exoskeleton assisting both the residual and intact limb induced a reduction of walking energy expenditure in four individuals with above-knee amputation. The reduction of the energy expenditure, quantified using the Physiological Cost Index, was in the range [-10, -17]% for all study participants compared to walking without assistance, and between [-2, -24]% in three out of four study participants compared to walking without the device. Additionally, all study participants were able to walk comfortably and confidently with the hip exoskeleton overground at both their self-selected comfortable and fast speed without any observable alterations in gait stability. The study findings confirm that injecting energy at the hip level is a promising approach for individuals with above-knee amputation. By reducing the energy expenditure of walking and facilitating gait, a hip exoskeleton may extend mobility and improve locomotor training of individuals with above-knee amputation, with several positive implications for their quality of life.
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Miller RH, Bell EM, Russell Esposito E. Transfemoral limb loss modestly increases the metabolic cost of optimal control simulations of walking. PeerJ 2024; 12:e16756. [PMID: 38223753 PMCID: PMC10785795 DOI: 10.7717/peerj.16756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Background In transtibial limb loss, computer simulations suggest that the maintenance of muscle strength between pre- and post-limb loss can maintain the pre-limb loss metabolic cost. These results are consistent with comparable costs found experimentally in select cases of high functioning military service members with transtibial limb loss. It is unlikely that similar results would be found with transfemoral limb loss, although the theoretical limits are not known. Here we performed optimal control simulations of walking with and without an above-knee prosthesis to determine if transfemoral limb loss per se increases the metabolic cost of walking. Methods OpenSim Moco was used to generate optimal control simulations of walking in 15 virtual "subjects" that minimized the weighted sum of (i) deviations from average able-bodied gait mechanics and (ii) the gross metabolic cost of walking, pre-limb loss in models with two intact biological limbs, and post-limb loss with one of the limbs replaced by a prosthetic knee and foot. No other changes were made to the model. Metabolic cost was compared between pre- and post-limb loss simulations in paired t-tests. Results Metabolic cost post-limb loss increased by 0.7-9.3% (p < 0.01) depending on whether cost was scaled by total body mass or biological body mass and on whether the prosthetic knee was passive or non-passive. Conclusions Given that the post-limb loss model had numerous features that predisposed it to low metabolic cost, these results suggest transfemoral limb loss per se increases the metabolic cost of walking. However, the large differences above able-bodied peers of ∼20-45% in most gait analysis experiments may be avoidable, even when minimizing deviations from able-bodied gait mechanics. Portions of this text were previously published as part of a preprint (https://www.biorxiv.org/content/10.1101/2023.06.26.546515v2.full.pdf).
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Affiliation(s)
- Ross H. Miller
- Department of Kinesiology, University of Maryland at College Park, College Park, MD, United States of America
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, United States of America
| | - Elizabeth M. Bell
- Department of Kinesiology, University of Maryland at College Park, College Park, MD, United States of America
- Department of Kinesiology, Towson University, Towson, MD, United States of America
| | - Elizabeth Russell Esposito
- Military Operational Medicine Research Program, Fort Detrick, MD, United States of America
- Extremity Trauma and Amputation Center of Excellence, Fort Sam Houston, TX, United States of America
- Center for Limb Loss and Mobility, VA Puget Sound Healthcare System, Seattle, WA, United States of America
- Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
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Seethapathi N, Jain AK, Srinivasan M. Walking speeds are lower for short distance and turning locomotion: Experiments and modeling in low-cost prosthesis users. PLoS One 2024; 19:e0295993. [PMID: 38166012 PMCID: PMC10760709 DOI: 10.1371/journal.pone.0295993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/04/2023] [Indexed: 01/04/2024] Open
Abstract
Preferred walking speed is a widely-used performance measure for people with mobility issues, but is usually measured in straight line walking for fixed distances or durations, and without explicitly accounting for turning. However, daily walking involves walking for bouts of different distances and walking with turning, with prior studies showing that short bouts with at most 10 steps could be 40% of all bouts and turning steps could be 8-50% of all steps. Here, we studied walking in a straight line for short distances (4 m to 23 m) and walking in circles (1 m to 3 m turning radii) in people with transtibial amputation or transfemoral amputation using a passive ankle-foot prosthesis (Jaipur Foot). We found that the study participants' preferred walking speeds are lower for shorter straight-line walking distances and lower for circles of smaller radii, which is analogous to earlier results in subjects without amputation. Using inverse optimization, we estimated the cost of changing speeds and turning such that the observed preferred walking speeds in our experiments minimizes the total cost of walking. The inferred costs of changing speeds and turning were larger for subjects with amputation compared to subjects without amputation in a previous study, specifically, being 4x to 8x larger for the turning cost and being highest for subjects with transfemoral amputation. Such high costs inferred by inverse optimization could potentially include non-energetic costs such as due to joint or interfacial stress or stability concerns, as inverse optimization cannot distinguish such terms from true metabolic cost. These experimental findings and models capturing the experimental trends could inform prosthesis design and rehabilitation therapy to better assist changing speeds and turning tasks. Further, measuring the preferred speed for a range of distances and radii could be a more comprehensive subject-specific measure of walking performance than commonly used straight line walking metrics.
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Affiliation(s)
- Nidhi Seethapathi
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Anil Kumar Jain
- Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
| | - Manoj Srinivasan
- Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States of America
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Knight AD, Jayaraman C, Elrod JM, Schnall BL, McGuire MS, Sleeman TJ, Hoppe-Ludwig S, Dearth CL, Hendershot BD, Jayaraman A. Functional Performance Outcomes of a Powered Knee-Ankle Prosthesis in Service Members With Unilateral Transfemoral Limb Loss. Mil Med 2023; 188:3432-3438. [PMID: 35895305 DOI: 10.1093/milmed/usac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/29/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Clinical knowledge surrounding functional outcomes of a powered knee-ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training. MATERIALS AND METHODS Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment. RESULTS All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis. CONCLUSIONS Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.
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Affiliation(s)
- Ashley D Knight
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services of the Health Sciences, Bethesda, MD 20814, USA
| | - Chandrasekaran Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Jonathan M Elrod
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Barri L Schnall
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Matt S McGuire
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Todd J Sleeman
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Shenan Hoppe-Ludwig
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Christopher L Dearth
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Walter Reed National Military Medical Center-Uniformed Services of the Health Sciences, Bethesda, MD 20814, USA
| | - Brad D Hendershot
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services of the Health Sciences, Bethesda, MD 20814, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA
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Lathouwers E, Baeyens JP, Tassignon B, Gomez F, Cherelle P, Meeusen R, Vanderborght B, De Pauw K. Continuous relative phases of walking with an articulated passive ankle-foot prosthesis in individuals with a unilateral transfemoral and transtibial amputation: an explorative case-control study. Biomed Eng Online 2023; 22:14. [PMID: 36793091 PMCID: PMC9933324 DOI: 10.1186/s12938-023-01074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND A mechanical ankle-foot prosthesis (Talaris Demonstrator) was developed to improve prosthetic gait in people with a lower-limb amputation. This study aims to evaluate the Talaris Demonstrator (TD) during level walking by mapping coordination patterns based on the sagittal continuous relative phase (CRP). METHODS Individuals with a unilateral transtibial amputation, transfemoral amputation and able-bodied individuals completed 6 minutes of treadmill walking in consecutive blocks of 2 minutes at self-selected (SS) speed, 75% SS speed and 125% SS speed. Lower extremity kinematics were captured and hip-knee and knee-ankle CRPs were calculated. Statistical non-parametric mapping was applied and statistical significance was set at 0.05. RESULTS The hip-knee CRP at 75% SS walking speed with the TD was larger in the amputated limb of participants with a transfemoral amputation compared to able-bodied individuals at the beginning and end of the gait cycle (p = 0.009). In people with a transtibial amputation, the knee-ankle CRP at SS and 125% SS walking speeds with the TD were smaller in the amputated limb at the beginning of the gait cycle compared to able-bodied individuals (p = 0.014 and p = 0.014, respectively). Additionally, no significant differences were found between both prostheses. However, visual interpretation indicates a potential advantage of the TD over the individual's current prosthesis. CONCLUSION This study provides lower-limb coordination patterns in people with a lower-limb amputation and reveals a possible beneficial effect of the TD over the individuals' current prosthesis. Future research should include a well-sampled investigation of the adaptation process combined with the prolonged effects of the TD.
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Affiliation(s)
- Elke Lathouwers
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Jean-Pierre Baeyens
- grid.8767.e0000 0001 2290 8069Experimental Anatomy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium ,THIM, Internationale Hochschule Fur Physiotherapîe, Landquart, Switzerland ,grid.5284.b0000 0001 0790 3681Faculty of Applied Engineering Sciences, Universiteit Antwerpen, Antwerp, Belgium
| | - Bruno Tassignon
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | | | - Romain Meeusen
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Bram Vanderborght
- grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Robotics Research Group, Vrije Universiteit Brussel and IMEC, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium. .,Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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Kooiman VGM, van Staveren ES, Leijendekkers RA, Buurke JH, Verdonschot N, Prinsen EC, Weerdesteyn V. Testing and evaluation of lower limb prosthesis prototypes in people with a transfemoral amputation: a scoping review on research protocols. J Neuroeng Rehabil 2023; 20:1. [PMID: 36635703 PMCID: PMC9835280 DOI: 10.1186/s12984-023-01125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/07/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND When developing new lower limb prostheses, prototypes are tested to obtain insights into the performance. However, large variations between research protocols may complicate establishing the potential added value of newly developed prototypes over other prostheses. OBJECTIVE This review aims at identifying participant characteristics, research protocols, reference values, aims, and corresponding outcome measures used during prosthesis prototype testing on people with a transfemoral amputation. METHODS A systematic search was done on PubMed and Scopus from 2000 to December 2020. Articles were included if testing was done on adults with transfemoral or knee disarticulation amputation; testing involved walking with a non-commercially available prototype leg prosthesis consisting of at least a knee component; and included evaluations of the participants' functioning with the prosthesis prototype. RESULTS From the initial search of 2027 articles, 48 articles were included in this review. 20 studies were single-subject studies and 4 studies included a cohort of 10 or more persons with a transfemoral amputation. Only 5 articles reported all the pre-defined participant characteristics that were deemed relevant. The familiarization time with the prosthesis prototype prior to testing ranged from 5 to 10 min to 3 months; in 25% of the articles did not mention the extent of the familiarization period. Mobility was most often mentioned as the development or testing aim. A total of 270 outcome measures were identified, kinetic/kinematic gait parameters were most often reported. The majority of outcome measures corresponded to the mobility aim. For 48% of the stated development aims and 4% of the testing aims, no corresponding outcome measure could be assigned. Results indicated large inconsistencies in research protocols and outcome measures used to validate pre-determined aims. CONCLUSIONS The large variation in prosthesis prototype testing and reporting calls for the development of a core set of reported participant characteristics, testing protocols, and specific and well-founded outcome measures, tailored to the various aims and development phases. The use of such a core set can give greater insights into progress of developments and determine which developments have additional benefits over the state-of-the-art. This review may contribute as initial input towards the development of such a core set.
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Affiliation(s)
- Vera G. M. Kooiman
- grid.10417.330000 0004 0444 9382Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eline S. van Staveren
- grid.419315.bRoessingh Research and Development, PO Box 310, 7500 AH Enschede, The Netherlands
| | - Ruud A. Leijendekkers
- grid.10417.330000 0004 0444 9382Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jaap H. Buurke
- grid.419315.bRoessingh Research and Development, PO Box 310, 7500 AH Enschede, The Netherlands ,Roessingh Center for Rehabilitation, Postbus 310, 7500 AH Enschede, The Netherlands ,grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Nico Verdonschot
- grid.10417.330000 0004 0444 9382Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Erik C. Prinsen
- grid.419315.bRoessingh Research and Development, PO Box 310, 7500 AH Enschede, The Netherlands ,grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Vivian Weerdesteyn
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Sint Maartenskliniek, Research & Rehabilitation, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands
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Ikeda AJ, Hurst EJ, Simon AM, Finucane SB, Hoppe-Ludwig S, Hargrove LJ. The impact of added mass placement on metabolic and temporal-spatial characteristics of transfemoral prosthetic gait. Gait Posture 2022; 98:240-247. [PMID: 36195049 DOI: 10.1016/j.gaitpost.2022.09.086] [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: 02/28/2022] [Revised: 08/20/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite prosthetic technology advancements, individuals with transfemoral amputation have compromised temporal-spatial gait parameters and high metabolic requirements for ambulation. It is unclear how adding mass at different locations on a transfemoral prosthesis might affect these outcomes. Research question Does walking with mass added at different locations on a transfemoral prosthesis affect temporal-spatial gait parameters and metabolic requirements compared to walking with no additional mass? METHODS Fourteen participants with unilateral transfemoral amputations took part. A 1.8 kg mass was added to their prostheses in three locations: Knee, just proximal to the prosthetic knee; Shank, mid-shank on the prosthesis; or Ankle, just proximal to the prosthetic foot. Temporal-spatial gait parameters were collected as participants walked over a GAITRite® walkway and metabolic data were collected during treadmill walking for each of these conditions and with no mass added, the None condition. Separate linear mixed effects models were created and post-hoc tests to compare with the control condition of None were performed with a significance level of 0.05. RESULTS Overground self-selected walking speed for Ankle was significantly slower than for None (p < 0.05) (None: 1.16 ± 0.24; Knee: 1.15 ± 0.19; Shank: 1.14 ± 0.24; Ankle 0.99 ± 0.20 m/s). Compared to None, Ankle showed significantly increased oxygen consumption during treadmill walking (p < 0.05) (None: 13.82 ± 2.98; Knee: 13.83 ± 2.82; Shank: 14.30 ± 2.89; Ankle 14.56 ± 2.99 ml O2/kg/min). Other metabolic outcomes (power, cost of transport, oxygen cost) showed similar trends. Knee and Shank did not have significant negative effects on any metabolic or temporal-spatial parameters, as compared to None (p > 0.05). Significance Results suggest that additional mass located mid-shank or further proximal on a transfemoral prosthesis may not have negative temporal-spatial or metabolic consequences. Clinicians, researchers, and designers may be able to utilize heavier components, as long as the center of mass is not further distal than mid-shank, without adversely affecting gait parameters or metabolic requirements.
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Affiliation(s)
- Andrea J Ikeda
- Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Emily J Hurst
- Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Ann M Simon
- Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Suzanne B Finucane
- Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Shenan Hoppe-Ludwig
- Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Levi J Hargrove
- Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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8
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Evaluation of an articulated passive ankle-foot prosthesis. Biomed Eng Online 2022; 21:28. [PMID: 35477464 PMCID: PMC9047309 DOI: 10.1186/s12938-022-00997-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Current ankle prostheses for people with unilateral transtibial amputation (TTA) or transfemoral amputation (TFA) are unable to mimic able-bodied performance during daily activities. A new mechanical ankle–foot prosthesis was developed to further optimise the gait of people with a lower-limb amputation. This study aimed to evaluate the Talaris Demonstrator (TD) during daily activities by means of performance-related, physiological and subjective outcome measures. Materials and methods Forty-two participants completed a protocol assessing performance and functional mobility with their current prosthesis and the TD. The protocol comprised the L-test, 2 min of stair climbing, 2 min of inclined treadmill walking, 6 min of treadmill walking at 3 different speeds in consecutive blocks of 2 min, and a 3-m Backward Walk test (3mBWT). Heart rate was measured during each task, and oxygen uptake was collected during all tasks except for the L-test and 3mBWT. Time of execution was recorded on the L-test and 3mBWT, and the rate of perceived exertion (score = 6–20), fatigue and comfort (score = 0–100) were assessed after each task. Paired sample t-tests and Wilcoxon Signed-rank tests were performed to compare outcomes between prosthetic devices. Benjamini–Hochberg corrections were applied to control for multiple comparisons with a level of significance set at α = 0.05. Results Subjects with a TTA (N = 28) were faster with their current prosthesis compared to the TD on the L-test and 3mBWT (p = 0.005). In participants with a TFA (N = 14), we observed a tendency towards a higher heart rate during the L-test and towards increased comfort during inclined walking, with the TD compared to the participants’ current prosthetic device (0.05 < p < 0.10). Further, no significant results were observed. Conclusion The Talaris Demonstrator is a novel state-of-the-art passive ankle–foot prosthesis for both people with a TTA and TFA. Subjective measures indicate the added value of this device, while overall task performance and intensity of effort do not differ between the Talaris Demonstrator and the current prosthesis. Further investigations unravelling both acute and more prolonged adaptations will be conducted to evaluate the TD more thoroughly.
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Knight AD, Dearth CL, Hendershot BD. Deleterious Musculoskeletal Conditions Secondary to Lower Limb Loss: Considerations for Prosthesis-Related Factors. Adv Wound Care (New Rochelle) 2021; 10:671-684. [PMID: 32320367 PMCID: PMC8568798 DOI: 10.1089/wound.2019.1079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/23/2020] [Indexed: 11/13/2022] Open
Abstract
Significance: The intent of this work was to summarize the existing evidence of, and highlight knowledge gaps specific to, prosthetic devices/componentry and training regimes, particularly in the context of the human-device interaction and deleterious musculoskeletal conditions secondary to lower limb loss. Recent Advances: With the recent and evolving technological advancements in prostheses, there are numerous devices available to individuals with lower limb loss. Current literature demonstrates the importance of expanding the knowledge of all prosthetic device-specific factors and the significance of proper prescription, fit, and alignment, along with adequate device-/activity-specific training, to enhance human-device interaction, reduce gait abnormalities and compensatory motions, and as a result, mitigate risk for secondary musculoskeletal conditions. Critical Issues: Inadequate device prescription, fit, alignment, and training are evident owing to the lack of knowledge or awareness of the many device-specific properties and factors, leading to suboptimal use, as well as, biomechanical compensations, which collectively and adversely affect the function, activity level, and overall health of the prosthesis user. Future Directions: To maximize optimal outcomes after lower limb loss, it is essential to better appreciate the factors that affect both prosthesis use and satisfaction, particularly any modifiable factors that might be targeted in rehabilitation interventions such as device prescription, fit/alignment, and training regimes. A better understanding of such device-specific factors will help enhance the human-device interaction and resulting functional performance, thereby reducing secondary musculoskeletal conditions, allowing for the readiness of the fighting force (return-to-duty/redeployment) and/or improved reintegration into civilian society/work, and overall enhancing quality of life after lower limb loss.
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Affiliation(s)
- Ashley D. Knight
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher L. Dearth
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brad D. Hendershot
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Ghillebert J, Geeroms J, Flynn L, De Bock S, Govaerts R, Lathouwers E, Crea S, Vitiello N, Lefeber D, Meeusen R, De Pauw K. Performance of the CYBERLEGs motorized lower limb prosthetic device during simulated daily activities. WEARABLE TECHNOLOGIES 2021; 2:e15. [PMID: 38486632 PMCID: PMC10936386 DOI: 10.1017/wtc.2021.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/17/2021] [Accepted: 10/29/2021] [Indexed: 03/17/2024]
Abstract
Background The CYBERLEGs-gamma (CLs-ɣ) prosthesis has been developed to investigate the possibilities of powerful active prosthetics in restoring human gait capabilities after lower limb amputation. Objective The objective of this study was to determine the performance of the CLs-ɣ prosthesis during simulated daily activities. Methods Eight participants with a transfemoral amputation (age: 55 ± 15 years, K-level 3, registered under: NCT03376919) performed a familiarization session, an experimental session with their current prosthesis, three training sessions with the CLs-ɣ prosthesis and another experimental session with the CLs-ɣ prosthesis. Participants completed a stair-climbing-test, a timed-up-and-go-test, a sit-to stand-test, a 2-min dual-task and a 6-min treadmill walk test. Results Comparisons between the two experimental sessions showed that stride length significantly increased during walking with the CLs-ɣ prosthesis (p = .012) due to a greater step length of the amputated leg (p = .035). Although a training period with the prototype was included, preferred walking speed was significantly slower (p = .018), the metabolic cost of transport was significantly higher (p = .028) and reaction times significantly worsened (p = .012) when walking with the CLs-ɣ compared to the current prosthesis. Conclusions It can be stated that a higher physical and cognitive effort were required when wearing the CLs-ɣ prosthesis. Positive outcomes were observed regarding stride length and stair ambulation. Future prosthetics development should minimize the weight of the device and integrate customized control systems. A recommendation for future research is to include several shorter training periods or a prolonged adaptation period.
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Affiliation(s)
- Jo Ghillebert
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Joost Geeroms
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Louis Flynn
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Sander De Bock
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Renée Govaerts
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Elke Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Piazza Martiri della Libertà, Pisa, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Piazza Martiri della Libertà, Pisa, Italy
| | - Dirk Lefeber
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program ‘Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics’, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program ‘Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics’, Vrije Universiteit Brussel, Brussels, Belgium
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11
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Kobayashi T, Hu M, Amma R, Hisano G, Murata H, Ichimura D, Hobara H. Effects of walking speed on magnitude and symmetry of ground reaction forces in individuals with transfemoral prosthesis. J Biomech 2021; 130:110845. [PMID: 34749160 DOI: 10.1016/j.jbiomech.2021.110845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 12/01/2022]
Abstract
Individuals with unilateral transfemoral amputation (uTFA) walk asymmetrically. Investigating gait symmetry in ground reaction force (GRF) is critical because asymmetric loading on the residual limb can result in injury. The aim of this study was to investigate the GRF of individuals with uTFA by systematically controlling their walking at eight speeds(2.0-5.5 km/h with increments of 0.5 km/h) on a treadmill. Forty-eight individuals participated in this study, which included 24 individuals with uTFA (K3 and K4) and 24 individuals without amputation. GRFs (anteroposterior, mediolateral, and vertical) of the prosthetic and intact limb steps were collected for the individuals with uTFA and those of the right limb were collected for the control group. Peak force values of the GRF components, temporal parameters, impulses, and their asymmetry ratios were investigated and statistically analyzed. With an increasing walking speed, the magnitude of GRF changed gradually; individuals with uTFA exhibited increased GRF asymmetry in the vertical and mediolateral components, while that of the anteroposterior component remained constant. uTFA individuals typically maintained a constant asymmetry ratio in the mediolateral and anteroposterior (braking and propulsive) GRF impulses across a wide range of walking speeds. This result suggests that individuals with uTFA may cope with various walking speeds by maintaining symmetric mediolateral and anteroposterior impulses. The data provided in this study can serve as normative data for the GRF and its symmetry across a range of walking speeds in individuals with uTFA.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ryo Amma
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan; Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Genki Hisano
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan; Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan; Research Fellow of Japan Society for the Promotion of Science (JSPS), Japan
| | - Hiroto Murata
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan; Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Hiroaki Hobara
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan.
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12
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General estimates of the energy cost of walking in people with different levels and causes of lower-limb amputation: a systematic review and meta-analysis. Prosthet Orthot Int 2021; 45:417-427. [PMID: 34538817 DOI: 10.1097/pxr.0000000000000035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Energy cost of walking (ECw) is an important determinant of walking ability in people with a lower-limb amputation. Large variety in estimates of ECw has been reported, likely because of the heterogeneity of this population in terms of level and cause of amputation and walking speed. OBJECTIVES To assess (1) differences in ECw between people with and without a lower-limb amputation, and between people with different levels and causes of amputation, and (2) the association between ECw and walking speed. STUDY DESIGN Systematic review and meta-analysis. METHODS We included studies that compared ECw in people with and without a lower-limb amputation. A meta-analysis was done to compare ECw between both groups, and between different levels and causes of amputation. A second analysis investigated the association between self-selected walking speed and ECw in people with an amputation. RESULTS Out of 526 identified articles, 25 were included in the meta-analysis and an additional 30 in the walking speed analysis. Overall, people with a lower-limb amputation have significantly higher ECw compared to people without an amputation. People with vascular transfemoral amputations showed the greatest difference (+102%) in ECw. The smallest difference (+12%) was found for people with nonvascular transtibial amputations. Slower self-selected walking speed was associated with substantial increases in ECw. CONCLUSION This study provides general estimates on the ECw in people with a lower-limb amputation, quantifying the differences as a function of level and cause of amputation, as well as the relationship with walking speed.
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13
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Slater L, Finucane S, Hargrove LJ. Knee extensor power predicts six-minute walk test performance in people with transfemoral amputations. PM R 2021; 14:445-451. [PMID: 33866679 DOI: 10.1002/pmrj.12606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lower-limb amputees have increased metabolic costs during walking that may be mitigated by maintaining quadriceps strength and power following amputation. However, there are no current studies investigating the relationship between thigh strength and walking performance in individuals with transfemoral amputation. OBJECTIVE To quantify the relationship between intact limb quadriceps strength in transfemoral amputees and six-minute walk test (6MWT) performance. DESIGN Descriptive laboratory study. SETTING Laboratory. PARTICIPANTS Eleven participants with unilateral transfemoral amputations from trauma or osteosarcoma (4 women/7 men, 46.21 ± 12.68 years old, 28.24 ± 20.57 years following amputation). INTERVENTIONS Strength and power testing on the intact limb followed by 6MWT with a flowmeter to measure oxygen uptake (VO2 ). MAIN OUTCOME MEASURES Strength included mass-normalized peak torque, average torque, and average power. 6MWT measures included total distance traveled and VO2 normalized to distance and mass. Significant correlations (P ≤ .05) were retained for a regression analysis. RESULTS Peak isokinetic knee extensor torque was correlated with total VO2 (r = -.60, P = .05) and distance traveled (r = .84, P = .001). Average isokinetic knee extensor torque was correlated with total VO2 (r = -.61, P = .046) and distance traveled (r = .85, P = .001). Average knee extensor power was correlated with total VO2 (r = -.67, P = .026) and distance traveled (r = .88, P < .001). Peak isometric knee extensor torque was correlated with distance traveled (r = .69, P = .019). Average power explained 77.2% of the variance in distance traveled during the 6MWT (P < .001) and average power explained 44.2% of the variance in total VO2 during the 6MWT (P = .026). CONCLUSIONS Knee extensor strength was correlated with performance on the 6MWT in individuals with unilateral transfemoral amputation. The strongest relationship was between isokinetic quadriceps power and distance traveled, which suggests that developing quadriceps power in the intact limb following amputation may be an important factor to reduce metabolic cost of walking and support a return to an active lifestyle.
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Affiliation(s)
- Lindsay Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Suzanne Finucane
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Levi J Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Departments of PM&R and Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
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14
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Lower Limb Inter-Joint Coordination of Unilateral Transfemoral Amputees: Implications for Adaptation Control. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10124072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The gait of transfemoral amputees can be made smoother by adjusting the inter-joint coordination of both lower limbs. In this study, we compared the inter-joint coordination of the amputated and non-amputated limbs of unilateral amputees to able-bodied controls. Eight amputees and eight able-bodied control participants were recruited. Walking speed, stance–swing time ratio, joint angle, joint angular velocity, and inter-joint coordination parameters—including continuous relative phase (CRP) and decomposition index (DI)—of the lower-limb joint pairs in stance and swing phases were investigated. Similarity of the CRP between groups was evaluated using cross-correlation measures and root-mean-square, and the variability of the CRP was examined by deviation phase (DP). There were significant differences between the amputated limbs and controls in CRP of hip–knee and knee–ankle in stance and swing, DP of knee–ankle and hip–ankle in stance, and DI of hip–knee in swing. For the non-amputated limbs, there were significant differences in CRP and DP of knee–ankle, and DI of hip–knee in swing compared to controls. The amputees utilized unique inter-joint coordination patterns for both limbs—particularly the hip joint—to compensate for the support-capability impairment due to limb salvage and ensure foot placement accuracy.
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15
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Carse B, Scott H, Brady L, Colvin J. A characterisation of established unilateral transfemoral amputee gait using 3D kinematics, kinetics and oxygen consumption measures. Gait Posture 2020; 75:98-104. [PMID: 31645007 DOI: 10.1016/j.gaitpost.2019.09.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/30/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Persons with unilateral transfemoral (UTF) amputation are known to walk with less efficiency than able-bodied individuals, therefore understanding the gait deviations that drive this inefficiency was considered to be important. RESEARCH QUESTIONS What are the differences in gait outcomes between persons with UTF amputation and able-bodied persons? What is the prevalence of specific gait deviations within this group? METHODS Using a cross-sectional study design, the level over ground gait of established prosthetics service users with UTF amputation using mechanical knee joints (n=60) were compared with able-bodied persons (n=10). Gait profile score, walking velocity, step length, step length symmetry ratio, step time symmetry ratio, vertical ground reaction force symmetry index, base of support, centre of mass deviation and metabolic energy expenditure were measured. All data were captured during walking on level ground at a self-selected speed. Prevalence of gait deviations for each UTF participant were assessed by inspection, using a predefined list of lower limb kinematic, upper body kinematic, ground reaction force and lower limb kinetic gait deviations. RESULTS Statistically significant between-groups differences across all outcome measures were found, with all p-values <0.005, and effect sizes ranging from 'large' to 'huge'. The most prevalent gait deviations included: lack of prosthetic knee flexion in early stance (98%); lack of hip extension on the prosthetic side in late stance (82%): increased trunk side flexion range of motion across the gait cycle (92%); reduced anterior propulsion force on the prosthetic side in late stance (100%) and reduced prosthetic hip adduction moment in early stance (96%). SIGNIFICANCE The results of this study indicate that the magnitude of the differences between UTF amputees and able-bodied persons, across a comprehensive range of gait measures, are such that significant research into all aspects of prosthetic rehabilitation to reduce these differences is clearly justified.
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Affiliation(s)
- Bruce Carse
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - Helen Scott
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - Laura Brady
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - John Colvin
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK.
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Lechler K, Frossard B, Whelan L, Langlois D, Müller R, Kristjansson K. Motorized Biomechatronic Upper and Lower Limb Prostheses-Clinically Relevant Outcomes. PM R 2019; 10:S207-S219. [PMID: 30269806 DOI: 10.1016/j.pmrj.2018.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/09/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
People with major limb amputations are severely impaired when it comes to activity, body structure and function, as well as participation. Demographic statistics predict a dramatic increase of this population and additional challenges with their increasing age and higher levels of amputation. Prosthetic use has been shown to have a positive impact on mobility and depression, thereby affecting the quality of life. Biomechatronic prostheses are at the forefront of prosthetic development. Actively powered designs are now regularly used for upper limb prosthetic fittings, whereas for lower limbs the clinical use of actively powered prostheses has been limited to a very low number of applications. Actively powered prostheses enhance restoration of the lost physical functions of an amputee but are yet to allow intuitive user control. This paper provides a review of the status of biomechatronic developments in upper and lower limb prostheses in the context of the various challenges of amputation and the clinically relevant outcomes. Whereas most of the evidence regarding lower limb prostheses addresses biomechanical issues, the evidence for upper limb prostheses relates to activities of daily living (ADL) and instrumental ADL through diverse outcome measures and tools.
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Affiliation(s)
- Knut Lechler
- Össur hf, R&D, Medical Office, Reykjavik, Iceland(∗).
| | | | - Lynsay Whelan
- Össur hf, Sales & Marketing, Remote Training Programs-OT Americas Prosthetics, Hilliard, OH(‡)
| | | | - Roy Müller
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany(¶)
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van Schaik L, Geertzen JHB, Dijkstra PU, Dekker R. Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis. PLoS One 2019; 14:e0213256. [PMID: 30893346 PMCID: PMC6426184 DOI: 10.1371/journal.pone.0213256] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 02/19/2019] [Indexed: 01/09/2023] Open
Abstract
Objective To systematically review the literature on the metabolic costs of activities of daily living (ADL) in persons with a lower limb amputation (LLA). Data sources A literature search was undertaken in the Pubmed, Embase, CINAHL, CENTRAL, and PsycINFO databases using keywords and synonyms for LLA, metabolic costs, and ADL. The last search was performed on November 29th, 2017. Study selection Studies were included if they met the following 2 criteria: participants were adults with a (unilateral or bilateral) LLA and metabolic costs were measured while participants performed a physical activity or ADL. Data extraction and synthesis Data of 1,912 participants from 61 studies were included in the systematic review and meta-analysis. The studies used different terms to describe metabolic costs. Participants were recruited in different settings, relatively healthy, with few comorbidities. Limited data were available on metabolic costs of other activities than walking with a prosthesis. A linear mixed model analysis was performed based on the means reported, with study as unit of analysis and test results of different groups and measurement conditions as repeated measures within the unit of analysis. Predictors entered in the analysis were e.g. level and reason of amputation, age, weight, and height. During walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Additionally, oxygen consumption was determined by the interaction terms walking speed x amputation level and walking speed squared. Heart rate was determined by the interaction term walking speed squared. Conclusion During walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Data on metabolic costs of other activities were limited. The poor quality of the studies and the relatively healthy participants limited generalizability of the results of the meta-analysis.
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Affiliation(s)
- Loeke van Schaik
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
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Chen C, Hanson M, Chaturvedi R, Mattke S, Hillestad R, Liu HH. Economic benefits of microprocessor controlled prosthetic knees: a modeling study. J Neuroeng Rehabil 2018; 15:62. [PMID: 30255802 PMCID: PMC6157253 DOI: 10.1186/s12984-018-0405-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value. To answer this question, the differential clinical outcomes and cost of microprocessor-controlled knees (MPK) compared to non-microprocessor controlled knees (NMPK) were assessed. METHODS We conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a 10-year time period for unilateral transfemoral Medicare amputees with a Medicare Functional Classification Level of 3 and 4 using estimates from the published literature and expert input. The results are summarized as an incremental cost effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPK compared to NMPK for each quality-adjusted life-year gained. All costs were adjusted to 2016 U.S. dollars and discounted using a 3% rate to the present time. RESULTS The results demonstrated that compared to NMPK over a 10-year time period: for every 100 persons, MPK results in 82 fewer major injurious falls, 62 fewer minor injurious falls, 16 fewer incidences of osteoarthritis, and 11 lives saved; on a per person per year basis, MPK reduces direct healthcare cost by $3676 and indirect cost by $909, but increases device acquisition and repair cost by $6287 and total cost by $1702; on a per person basis, MPK is associated with an incremental total cost of $10,604 and increases the number of life years by 0.11 and quality adjusted life years by 0.91. MPK has an ICER ratio of $11,606 per quality adjusted life year, and the economic benefits of MPK are robust in various sensitivity analyses. CONCLUSIONS Advanced prosthetics for transfemoral amputees, specifically MPKs, are associated with improved clinical benefits compared to non-MPKs. The economic benefits of MPKs are similar to or even greater than those of other medical technologies currently reimbursed by U.S. payers.
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Affiliation(s)
- Christine Chen
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark Hanson
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Ritika Chaturvedi
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202-5050, USA
| | - Soeren Mattke
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA
| | | | - Harry H Liu
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA.
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