Kinematics of gait using bionic and hydraulic knee joints in transfemoral amputees

Normalized kinematic walking symmetry data for individuals who use lower-limb prostheses: considerations for clinical practice and future research

Introduction

Individuals who use unilateral transtibial or transfemoral prostheses have negative secondary health effects associated with decreased kinematic (e.g., spatiotemporal and joint angle) walking symmetry between prosthetic and intact limbs. Research studies have quantified kinematic walking symmetry, but studies can be difficult to compare owing to the inclusion of small sample sizes and differences in participant demographics, biomechanical parameters, and mathematical analysis of symmetry. This review aims to normalize kinematic walking symmetry research data across studies by level of limb loss and prosthetic factors to inform considerations in clinical practice and future research.

Methods

A search was performed on March 18, 2020, in PubMed, Scopus, and Google Scholar to encompass kinematic walking symmetry literature from the year 2000. First, the most common participant demographics, kinematic parameters, and mathematical analysis of symmetry were identified across studies. Then, the most common mathematical analysis of symmetry was used to recalculate symmetry data across studies for the five most common kinematic parameters.

Results

Forty-four studies were included in this review. The most common participant demographics were younger adults with traumatic etiology who used componentry intended for higher activity levels. The most common kinematic parameters were step length, stance time, and sagittal plane ankle, knee, and hip range of motion. The most common mathematical analysis was a particular symmetry index equation.

Conclusions

Normalization of data showed that symmetry tended to decrease as level of limb loss became more proximal and to increase with prosthetic componentry intended for higher activity levels. However, most studies included 10 or fewer individuals who were active younger adults with traumatic etiologies.

Clinical Relevance

Data summarized in this review could be used as reference values for rehabilitation and payer justification. Specifically, these data can help guide expectations for magnitudes of walking symmetry throughout rehabilitation or to justify advanced prosthetic componentry for active younger adults under 65 years of age with traumatic etiologies to payers.

Rules-Based Real-Time Gait Event Detection Algorithm for Lower-Limb Prosthesis Users during Level-Ground and Ramp Walking

Real-time gait event detection (GED) using inertial sensors is important for applications such as remote gait assessments, intelligent assistive devices including microprocessor-based prostheses or exoskeletons, and gait training systems. GED algorithms using acceleration and/or angular velocity signals achieve reasonable performance; however, most are not suited for real-time applications involving clinical populations walking in free-living environments. The aim of this study was to develop and evaluate a real-time rules-based GED algorithm with low latency and high accuracy and sensitivity across different walking states and participant groups. The algorithm was evaluated using gait data collected from seven able-bodied (AB) and seven lower-limb prosthesis user (LLPU) participants for three walking states (level-ground walking (LGW), ramp ascent (RA), ramp descent (RD)). The performance (sensitivity and temporal error) was compared to a validated motion capture system. The overall sensitivity was 98.87% for AB and 97.05% and 93.51% for LLPU intact and prosthetic sides, respectively, across all walking states (LGW, RA, RD). The overall temporal error (in milliseconds) for both FS and FO was 10 (0, 20) for AB and 10 (0, 25) and 10 (0, 20) for the LLPU intact and prosthetic sides, respectively, across all walking states. Finally, the overall error (as a percentage of gait cycle) was 0.96 (0, 1.92) for AB and 0.83 (0, 2.08) and 0.83 (0, 1.66) for the LLPU intact and prosthetic sides, respectively, across all walking states. Compared to other studies and algorithms, the herein-developed algorithm concurrently achieves high sensitivity and low temporal error with near real-time detection of gait in both typical and clinical populations walking over a variety of terrains.

A Review of the Potential of Virtual Walking Techniques for Gait Rehabilitation

Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait disturbances in different cohorts of patients (such as Parkinson's disease, post-stroke, or other neurological disorders) as it allows patients to be engaged in an immersive and artificial environment, which can be designed to address the particular needs of each individual. This review demonstrates the state of the art in applications of virtual walking techniques and related technologies for gait therapy and rehabilitation of people with movement disorders makes recommendations for future research and discusses the use of VR in the clinic. However, the potential for using these techniques in gait rehabilitation is to provide a more personalized approach by simulate the experience of natural walking, while patients with neurological disorders are maintained localized in the real world. The goal of our work is to investigate how the human nervous system controls movement in health and neurodegenerative disease.

CLINICAL GAIT ANALYSIS OF SUBJECTS WITH TRANS-FEMORAL AMPUTATION USING POLYCENTRIC FOUR-BAR LINKAGE PROSTHETIC KNEE JOINT

Background: Adequate research is not reported so far to underline the influence of commonly used polycentric knee joints on gait performance of subjects with trans-femoral amputation. Objective: The intent of this investigation is to analyze prosthetic gait of unilateral traumatic trans-femoral amputees with polycentric four-bar linkage knee and compare it with normal subjects for evaluating any asymmetry in gait performance. Methods: Objective three-dimensional gait analysis of 15 subjects [mean (age): 36.4 (10.7) years] were performed in gait lab through force plate and optoelectronic devices to measure temporal-spatial parameters, kinematic and kinetic performances. Gait patterns of amputees were compared with those of 15 individuals with normal gait to analyze distinct functionalities of existing polycentric knee. Results: Asymmetry in gait was observed between amputees and normal subjects for all variables concerned ([Formula: see text]). Amputee gait was with significantly lesser velocity, cadence with shorter step and stride length. There was significantly less hip, knee and pelvic motions, however, pelvic obliquity and rotation did not show significant difference from the normal subjects. The vertical component of the ground reaction force differed significantly between prosthetic and intact limb [49.7 (8.5)% and 90.4 (7.4)% body weight] and also from normal subjects [107.5 (2.4)% body weight] during stance ([Formula: see text]). Interpretation and Conclusion: This difference may be attributed to nonproportionate loading of limbs and mechanical adaptations for counteracting deficiencies of prosthetic side. This study will help to explain gait asymmetry in trans-femoral amputees and to identify underlying mechanisms to enhance the quality of the existing design of prosthetic knee through optimizing design parameters and utilizing appropriate materials.

The effects of domestic mechanical knee joints on pelvic motion in transfemoral amputees

PURPOSE

Pelvic asymmetry in the sagittal and horizontal planes among prosthesis users is related to the strength of the abdominal and back muscles. Considering that lumbosacral pathologies and pain in long-term transfemoral prosthesis users can cause asymmetric pelvic motion, it is necessary to investigate pelvic asymmetry caused by prosthetic components. The aim was to compare the gait symmetry of the pelvis of active transfemoral amputees using different types of prosthetic knee joints (Non-microprocessor-controlled prostheses (NMCPs) and microprocessor-controlled prostheses (MCP) knees).

METHODS

The two patient groups comprised eight transfemoral amputees: four patients had NMCP joints (Turkish products), and four patients had MCP knees. The reference group consisted of ten normal volunteers. In this work, the 3-D motion of the pelvis, hip, knee and ankle was assessed using the VICON system.

RESULTS

The results revealed that during stance, the kinematics of pelvic movement in the amputee group differed from those of the control group in terms of the total excursion anterior pelvic tilt (APT) and maximum and minimum degrees of APT (p < .05). We evaluated the graphics of the NMCP and MCP knee joints and found that the prosthesis-side APT was closer to that of the control group during the stance phase among the NMCP users, while the APT of the MCP users was closer to that of the control group during the swing phase.

CONCLUSION

The investigated MCP benefitted the patients considerably. The NMCP did not provide as much walking as the MCP but produced less APT.Implications for RehabilitationThe MCP may not provide symmetrical pelvic motion during all phases of the gait cycle. In transfemoral amputees using MCP, focusing on pelvis in walking training will contribute to pre-prosthetic and post-prosthetics rehabilitation.The NMCP knee joint may be closer in terms of APT.

Performance Evaluation of Jaipur Knee Joint through Kinematics and Kinetics Gait Symmetry with Unilateral Transfemoral Indian Amputees

Gait analysis is considered as the most systematic study of human motion. The analysis of gait includes visual and analytical perception of the individual, augmentation of various mechanical instrumentations for measuring movement of body, muscles activity and body mechanics. Past study focused on gait analysis of various animal locomotion and humans mainly on sports biomechanics. This paper aims to quantify the gait performance with Jaipur Knee, which is one of the most widely used prosthesis in Indian population. Gait data with Jaipur knee joint is not available till date. The proposed study targets to predict the performance of Jaipur knee joint in terms of gait symmetry with transfemoral Indian amputees. Gait symmetry may be the basis of recommendation of knee joint to prosthetic patients. This study used kinematics and kinetics parameters together to quantify the performance of Jaipur knee joint to evaluate gait symmetry. This research will be helpful for clinician to predict and further to prevent the degenerated musculoskeletal effects generally seen in unilateral transfemoral amputees.