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Fougeron N, Bonnet X, Panhelleux B, Rose JL, Rohan PY, Pillet H. Effect of the ischial support on muscle force estimation during transfemoral walking. Prosthet Orthot Int 2025; 49:51-59. [PMID: 38619545 DOI: 10.1097/pxr.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Transmission of loads between the prosthetic socket and the residual limb is critical for the comfort and walking ability of people with transfemoral amputation. This transmission is mainly determined by the socket tightening, muscle forces, and socket ischial support. However, numerical investigations of the amputated gait, using modeling approaches such as MusculoSkeletal (MSK) modeling, ignore the weight-bearing role of the ischial support. This simplification may lead to errors in the muscle force estimation. OBJECTIVE This study aims to propose a MSK model of the amputated gait that accounts for the interaction between the body and the ischial support for the estimation of the muscle forces of 13 subjects with unilateral transfemoral amputation. METHODS Contrary to previous studies on the amputated gait which ignored the interaction with the ischial support, here, the contact on the ischial support was included in the external loads acting on the pelvis in a MSK model of the amputated gait. RESULTS Including the ischial support induced an increase in the activity of the main abductor muscles, while adductor muscles' activity was reduced. These results suggest that neglecting the interaction with the ischial support leads to erroneous muscle force distribution considering the gait of people with transfemoral amputation. Although subjects with various bone geometries, particularly femur lengths, were included in the study, similar results were obtained for all subjects. CONCLUSIONS Eventually, the estimation of muscle forces from MSK models could be used in combination with finite element models to provide quantitative data for the design of prosthetic sockets.
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Affiliation(s)
- Nolwenn Fougeron
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
- Proteor, Recherche et développement, Dijon, France
| | - Xavier Bonnet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Brieuc Panhelleux
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
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Alam MF, Zaki S, Sharma S, Nuhmani S. Establishing the Reliability of the GaitON ® Motion Analysis System: A Foundational Study for Gait and Posture Analysis in a Healthy Population. SENSORS (BASEL, SWITZERLAND) 2024; 24:6884. [PMID: 39517782 PMCID: PMC11870036 DOI: 10.3390/s24216884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/23/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Gait and posture analysis plays a crucial role in understanding human movement, with significant applications in rehabilitation, sports science, and clinical settings. The GaitON® system, a 2D motion analysis tool, provides an accessible and cost-effective method for assessing gait and posture. However, its reliability in clinical practice, particularly for intra-rater consistency, remains to be evaluated. This study aims to assess the intra-rater reliability of the GaitON® system in a healthy population, focusing on gait and posture parameters. METHODS A total of 20 healthy participants (10 males and 10 females) aged 18 to 50 years were recruited for the study. Each participant underwent gait and posture assessments using the GaitON® system on two separate occasions, spaced one week apart. Video recordings from anterior and posterior views were used to analyze gait, while images from anterior, posterior, and lateral views were captured to assess posture with markers placed on key anatomical landmarks. The reliability of the measurements was analyzed using intraclass correlation coefficients (ICC), a standard error of measurement (SEM), and the smallest detectable difference (SDD) method. RESULTS The GaitON® system demonstrated excellent intra-rater reliability across a wide range of gait and posture parameters. ICC values for gait parameters, including hip, knee, and ankle joint angles, ranged from 0.90 to 0.979, indicating strong consistency in repeated measurements. Similarly, ICC values for posture parameters, such as the head alignment, shoulder position, and ASIS alignment, were above 0.90, reflecting excellent reliability. SEM values were low across all parameters, with the smallest SEM recorded for the hip joint angle (0.37°), and SDD values further confirmed the precision of the system. CONCLUSION The GaitON® system provides reliable and consistent measurements for both gait and posture analysis in healthy individuals. Its high intra-rater reliability and low measurement error make it a promising tool for clinical and sports applications. Further research is needed to validate its use in clinical populations and compare its performance to more complex 3D motion analysis systems.
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Affiliation(s)
- Md Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Muhammad Ali Jauhar Marg, New Delhi 110025, India; (M.F.A.); or (S.Z.)
| | - Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Muhammad Ali Jauhar Marg, New Delhi 110025, India; (M.F.A.); or (S.Z.)
- Department of Physiotherapy, Sharda School of Allied Health Sciences, Sharda University, Greater Noida 201310, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Muhammad Ali Jauhar Marg, New Delhi 110025, India; (M.F.A.); or (S.Z.)
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
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Dupuis F, Ginis KAM, MacKay C, Best KL, Blanchette V, Cherif A, Robert MT, Miller WC, Gee C, Habra N, Brousseau-Foley M, Zidarov D. Do Exercise Programs Improve Fitness, Mobility, and Functional Capacity in Adults With Lower Limb Amputation? A Systematic Review on the Type and Minimal Dose Needed. Arch Phys Med Rehabil 2024; 105:1194-1211. [PMID: 37926223 DOI: 10.1016/j.apmr.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? DESIGN Systematic review. SETTING Outpatient intervention, outside of the prosthetic rehabilitation phase. PARTICIPANTS Adults with lower limb amputation living in the community. INTERVENTION Any physical activity or exercise intervention. OUTCOMES AND MEASURES Any fitness, mobility, or functional capacity indicators and measurements. RESULTS Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower-limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. CONCLUSION Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status.
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Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - Kathleen A Martin Ginis
- Department of Medicine and Centre for Chronic Disease Prevention and Management and International Collaboration on Repair Discoveries, Faculty of Medicine, School of Health and Exercise Sciences, Faculty of Health and Social Development, and Reichwald Health Sciences Centre, University of British Columbia, Kelowna, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, York, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Krista L Best
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - Virginie Blanchette
- Université du Québec à Trois-Rivières, Department of Human Kinetics and Podiatric Medicine and VITAM: Sustainable Health Research Centre, Trois-Rivières, Canada
| | - Amira Cherif
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - Maxime T Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - William C Miller
- University of British Columbia, Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Vancouver, Canada
| | - Cameron Gee
- University of British Columbia, Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Vancouver, Canada
| | - Natalie Habra
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Magalie Brousseau-Foley
- Université du Québec à Trois-Rivières, Department of Human Kinetics and Podiatric Medicine, Trois-Rivières, Canada
| | - Diana Zidarov
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.
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Maikos JT, Pruziner AL, Hendershot BD, Herlihy DV, Chomack JM, Hyre MJ, Phillips SL, Sidiropoulos AN, Dearth CL, Nelson LM. Effects of a Powered Ankle-Foot Prosthesis and Physical Therapy on Function for Individuals With Transfemoral Limb Loss: Rationale, Design, and Protocol for a Multisite Clinical Trial. JMIR Res Protoc 2024; 13:e53412. [PMID: 38277197 PMCID: PMC10858430 DOI: 10.2196/53412] [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: 10/06/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Powered ankle-foot prosthetic devices can generate net positive mechanical work during gait, which mimics the physiological ankle. However, gait deviations can persist in individuals with transfemoral limb loss because of habit or lack of rehabilitation. Prosthetic research efforts favor the design or evaluation of prosthetic componentry and rarely incorporate any type of rehabilitation, despite evidence suggesting that it is critical for minimizing gait imbalances. Given the accelerated rate of innovation in prosthetics, there is a fundamental knowledge gap concerning how individuals with transfemoral limb loss should learn to correctly use powered ankle-foot devices for maximum functional benefit. Because of the recent advances in prosthetic technology, there is also a critical unmet need to develop guidelines for the prescription of advanced prosthetic devices that incorporate both physical and psychological components to identify appropriate candidates for advanced technology. OBJECTIVE The primary goal of this investigation is to examine the roles of advanced prosthetic technology and a device-specific rehabilitative intervention on gait biomechanics, functional efficacy, and pain in individuals with transfemoral limb loss. The secondary goal is to develop preliminary rehabilitation guidelines for advanced lower limb prosthetic devices to minimize gait imbalances and maximize function and to establish preliminary guidelines for powered ankle-foot prosthetic prescription. METHODS This prospective, multisite study will enroll 30 individuals with unilateral transfemoral limb loss. At baseline, participants will undergo a full gait analysis and assessment of function, neurocognition, cognitive load, subjective preferences, and pain using their current passive prosthesis. The participants will then be fitted with a powered ankle-foot device and randomized into 2 equal groups: a powered device with a device-specific rehabilitation intervention (group A) or a powered device with the current standard of practice (group B). Group A will undergo 4 weeks of device-specific rehabilitation. Group B will receive the current standard of practice, which includes basic device education but no further device-specific rehabilitation. Data collection procedures will then be repeated after 4 weeks and 8 weeks of powered ankle use. RESULTS This study was funded in September 2017. Enrollment began in September 2018. Data collection will conclude by March 2024. The initial dissemination of results is expected in August 2024. CONCLUSIONS The projected trends indicate that the number of individuals with limb loss will dramatically increase in the United States. The absence of effective, evidence-based interventions may make individuals with transfemoral limb loss more susceptible to increased secondary physical conditions and degenerative changes. With this expected growth, considerable resources will be required for prosthetic and rehabilitation services. Identifying potential mechanisms for correcting gait asymmetries, either through advanced prosthetic technology or rehabilitative interventions, can provide a benchmark for understanding the optimal treatment strategies for individuals with transfemoral limb loss. TRIAL REGISTRATION ClinicalTrials.gov NCT03625921; https://clinicaltrials.gov/study/NCT03625921. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53412.
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Affiliation(s)
- Jason T Maikos
- Veterans Affairs New York Harbor Healthcare System, New York, NY, United States
| | - Alison L Pruziner
- Walter Reed National Military Medical Center, Bethesda, MD, United States
- Extremity Trauma and Amputation Center of Excellence, Falls Church, VA, United States
- National Veterans Sports Programs and Special Events, Department of Veterans Affairs, Washington, DC, United States
| | - Brad D Hendershot
- Walter Reed National Military Medical Center, Bethesda, MD, United States
- Extremity Trauma and Amputation Center of Excellence, Falls Church, VA, United States
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David V Herlihy
- The Narrows Institute for Biomedical Research and Education, Brooklyn, NY, United States
| | - John M Chomack
- The Narrows Institute for Biomedical Research and Education, Brooklyn, NY, United States
| | - Michael J Hyre
- The Narrows Institute for Biomedical Research and Education, Brooklyn, NY, United States
| | | | | | - Christopher L Dearth
- Walter Reed National Military Medical Center, Bethesda, MD, United States
- Extremity Trauma and Amputation Center of Excellence, Falls Church, VA, United States
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Leif M Nelson
- Veterans Affairs New York Harbor Healthcare System, New York, NY, United States
- Extremity Trauma and Amputation Center of Excellence, Falls Church, VA, United States
- National Veterans Sports Programs and Special Events, Department of Veterans Affairs, Washington, DC, United States
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Finco MG, Moudy SC, Patterson RM. Normalized kinematic walking symmetry data for individuals who use lower-limb prostheses: considerations for clinical practice and future research. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2023; 35:e1-e17. [PMID: 37008386 PMCID: PMC10062529 DOI: 10.1097/jpo.0000000000000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT
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.
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Affiliation(s)
- M G Finco
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Sarah C Moudy
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Rita M Patterson
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
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Clinical and Demographic Factors Influencing the Asymmetry of Gait in Lower-Limb Prosthetic Users. Symmetry (Basel) 2022. [DOI: 10.3390/sym14091910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
(1) Background: A lower limb prosthesis replaces a lost body part with a differential representation of gait function and its symmetry. Many physical, personal, and specific factors in amputees influence gait asymmetry. The aim of this study was to determine the factors influencing the asymmetry of gait in amputated patients. (2) Methods: The study group consisted of 12 people. Gait quality was assessed using the MoCap OptiTrack® Motion Capture System and the results were correlated with demographic factors (age, gender), morphological features (height, weight), amputation-related factors (cause and side of amputation, prosthesis time, and prosthesis fixation), and ailment pain. The control group consisted of 12 people. (3) Results: In the study group, a positive correlation between the mean walking speed and height in the study group was demonstrated, as well as a positive correlation between the difference in ROM and height, and a negative correlation between the mean walking speed and age. A negative correlation between the difference in ROM and age was found in both groups. A positive correlation was found between the width of the support and the weight in the control group. No other statistical relationship with the parameters describing gait asymmetry was found. (4) Conclusions: Statistical analysis showed that mean walking speed and ROM difference in the study group were positively related to height and negatively to age. No other statistical relationship with the parameters describing gait asymmetry was found.
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Persine S, Leteneur S, Gillet C, Bassement J, Charlaté F, Simoneau-Buessinger E. Walking abilities improvements are associated with pelvis and trunk kinematic adaptations in transfemoral amputees after rehabilitation. Clin Biomech (Bristol, Avon) 2022; 94:105619. [PMID: 35306365 DOI: 10.1016/j.clinbiomech.2022.105619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/26/2022] [Accepted: 03/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rehabilitation can be proposed to transfemoral amputees to improve functional abilities and limit the risk of early degeneration of the musculoskeletal system partly due to altered kinematic behavior. The main aim of this study was to assess the impact of functional rehabilitation on clinical walking tests, gait symmetry and pelvis and trunk kinematics in transfemoral amputees during overground walking. METHODS Eleven transfemoral amputees followed a functional rehabilitation program with objectives aimed at improving walking abilities and gait symmetry. Clinical functional tests, symmetry between prosthetic and intact sides and trunk and pelvis motions were recorded before and after rehabilitation. FINDINGS Clinical walking tests were improved after rehabilitation (p < 0.05), and step width was reduced (p = 0.04). Regarding symmetry between the single stances on the prosthesis and intact sides, only a significant decrease in trunk frontal inclination asymmetry was noted after rehabilitation (p = 0.01). Pelvic frontal obliquity was significantly increased during prosthetic (p = 0.02) and intact single stances (p = 0.005). INTERPRETATION Our study showed a positive effect of rehabilitation on transfemoral amputees functional abilities. These improvements were associated with higher pelvic mobility in frontal plane and a more symmetrical redistribution of the frontal trunk sway around the vertical axis during gait. These results suggest the importance of a postural reeducation program for transfemoral amputees aimed at improving pelvic dynamic control while repositioning the trunk by postural corrections during gait.
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Affiliation(s)
- S Persine
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
| | - S Leteneur
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - C Gillet
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - J Bassement
- Centre Hospitalier de Valenciennes, Valenciennes, France
| | - F Charlaté
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France
| | - E Simoneau-Buessinger
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
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Does the socket design affect symmetry and spatiotemporal gait parameters? A case series of two transfemoral amputees. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roggio F, Ravalli S, Maugeri G, Bianco A, Palma A, Di Rosa M, Musumeci G. Technological advancements in the analysis of human motion and posture management through digital devices. World J Orthop 2021; 12:467-484. [PMID: 34354935 PMCID: PMC8316840 DOI: 10.5312/wjo.v12.i7.467] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/15/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
Technological development of motion and posture analyses is rapidly progressing, especially in rehabilitation settings and sport biomechanics. Consequently, clear discrimination among different measurement systems is required to diversify their use as needed. This review aims to resume the currently used motion and posture analysis systems, clarify and suggest the appropriate approaches suitable for specific cases or contexts. The currently gold standard systems of motion analysis, widely used in clinical settings, present several limitations related to marker placement or long procedure time. Fully automated and markerless systems are overcoming these drawbacks for conducting biomechanical studies, especially outside laboratories. Similarly, new posture analysis techniques are emerging, often driven by the need for fast and non-invasive methods to obtain high-precision results. These new technologies have also become effective for children or adolescents with non-specific back pain and postural insufficiencies. The evolutions of these methods aim to standardize measurements and provide manageable tools in clinical practice for the early diagnosis of musculoskeletal pathologies and to monitor daily improvements of each patient. Herein, these devices and their uses are described, providing researchers, clinicians, orthopedics, physical therapists, and sports coaches an effective guide to use new technologies in their practice as instruments of diagnosis, therapy, and prevention.
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Affiliation(s)
- Federico Roggio
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo 90144, Italy
| | - Silvia Ravalli
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania 95123, Italy
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania 95123, Italy
| | - Antonino Bianco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo 90144, Italy
| | - Antonio Palma
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo 90144, Italy
| | - Michelino Di Rosa
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania 95123, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania 95123, Italy
- Research Center on Motor Activities, University of Catania, Catania 95123, Italy
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, United States
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Sanz-Morère CB, Martini E, Meoni B, Arnetoli G, Giffone A, Doronzio S, Fanciullacci C, Parri A, Conti R, Giovacchini F, Friðriksson Þ, Romo D, Crea S, Molino-Lova R, Vitiello N. Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study. J Neuroeng Rehabil 2021; 18:111. [PMID: 34217307 PMCID: PMC8254913 DOI: 10.1186/s12984-021-00902-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Background Transfemoral amputation is a serious intervention that alters the locomotion pattern, leading to secondary disorders and reduced quality of life. The outcomes of current gait rehabilitation for TFAs seem to be highly dependent on factors such as the duration and intensity of the treatment and the age or etiology of the patient. Although the use of robotic assistance for prosthetic gait rehabilitation has been limited, robotic technologies have demonstrated positive rehabilitative effects for other mobility disorders and may thus offer a promising solution for the restoration of healthy gait in TFAs. This study therefore explored the feasibility of using a bilateral powered hip orthosis (APO) to train the gait of community-ambulating TFAs and the effects on their walking abilities. Methods Seven participants (46–71 years old with different mobility levels) were included in the study and assigned to one of two groups (namely Symmetry and Speed groups) according to their prosthesis type, mobility level, and prior experience with the exoskeleton. Each participant engaged in a maximum of 12 sessions, divided into one Enrollment session, one Tuning session, two Assessment sessions (conducted before and after the training program), and eight Training sessions, each consisting of 20 minutes of robotically assisted overground walking combined with additional tasks. The two groups were assisted by different torque-phase profiles, aiming at improving symmetry for the Symmetry group and at maximizing the net power transferred by the APO for the Speed group. During the Assessment sessions, participants performed two 6-min walking tests (6mWTs), one with (Exo) and one without (NoExo) the exoskeleton, at either maximal (Symmetry group) or self-selected (Speed group) speed. Spatio-temporal gait parameters were recorded by commercial measurement equipment as well as by the APO sensors, and metabolic efficiency was estimated via the Cost of Transport (CoT). Additionally, kinetic and kinematic data were recorded before and after treatment in the NoExo condition.
Results The one-month training protocol was found to be a feasible strategy to train TFAs, as all participants smoothly completed the clinical protocol with no relevant mechanical failures of the APO. The walking performance of participants improved after the training. During the 6mWT in NoExo, participants in the Symmetry and Speed groups respectively walked 17.4% and 11.7% farther and increased walking speed by 13.7% and 17.9%, with improved temporal and spatial symmetry for the former group and decreased energetic expenditure for the latter. Gait analysis showed that ankle power, step width, and hip kinematics were modified towards healthy reference levels in both groups. In the Exo condition metabolic efficiency was reduced by 3% for the Symmetry group and more than 20% for the Speed group. Conclusions This study presents the first pilot study to apply a wearable robotic orthosis (APO) to assist TFAs in an overground gait rehabilitation program. The proposed APO-assisted training program was demonstrated as a feasible strategy to train TFAs in a rehabilitation setting. Subjects improved their walking abilities, although further studies are required to evaluate the effectiveness of the APO compared to other gait interventions. Future protocols will include a lighter version of the APO along with optimized assistive strategies.
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Affiliation(s)
| | - Elena Martini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy
| | - Barbara Meoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy
| | | | | | - Stefano Doronzio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy
| | | | - Andrea Parri
- IUVO S.R.L, Via Puglie, 9, 56025, Pontedera, Pisa, Italy
| | - Roberto Conti
- IUVO S.R.L, Via Puglie, 9, 56025, Pontedera, Pisa, Italy
| | | | | | - Duane Romo
- Össur, Grjótháls 5, 110, Reykjavík, Iceland
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy.,IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.,Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| | | | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy.,IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.,Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
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Abstract
In the original edition of Prosthetics and Orthotics International, Dr Sidney Fishman identified what he anticipated as foundational educational needs for the emerging field of clinical prosthetics and orthotics. Within the broader construct of the physical sciences, this included mathematics, physics, chemistry, biomechanics, and material sciences. The clinical application of these disciplines to expanding the collective understanding within the field is described, including the biomechanics of able-bodied and prosthetic gait, the material science of socket construction, the physics of suspension and load distribution, and the engineering of prosthetic components to mimic human biomechanics. Additional applications of the physical sciences to upper limb prosthetics and lower limb orthotics are also described. In contemplating the continued growth and maturation of the field in the years to come, mechatronics and statistics are suggested as future areas where clinical proficiency will be required.
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Affiliation(s)
- Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, UT, USA.,Division of Physical Medicine and Rehabilitation, University of Utah Healthcare, Salt Lake City, UT, USA
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12
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Escamilla-Nunez R, Michelini A, Andrysek J. Biofeedback Systems for Gait Rehabilitation of Individuals with Lower-Limb Amputation: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1628. [PMID: 32183338 PMCID: PMC7146745 DOI: 10.3390/s20061628] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Individuals with lower-limb amputation often have gait deficits and diminished mobility function. Biofeedback systems have the potential to improve gait rehabilitation outcomes. Research on biofeedback has steadily increased in recent decades, representing the growing interest toward this topic. This systematic review highlights the methodological designs, main technical and clinical challenges, and evidence relating to the effectiveness of biofeedback systems for gait rehabilitation. This review provides insights for developing an effective, robust, and user-friendly wearable biofeedback system. The literature search was conducted on six databases and 31 full-text articles were included in this review. Most studies found biofeedback to be effective in improving gait. Biofeedback was most commonly concurrently provided and related to limb loading and symmetry ratios for stance or step time. Visual feedback was the most used modality, followed by auditory and haptic. Biofeedback must not be obtrusive and ideally provide a level of enjoyment to the user. Biofeedback appears to be most effective during the early stages of rehabilitation but presents some usability challenges when applied to the elderly. More research is needed on younger populations and higher amputation levels, understanding retention as well as the relationship between training intensity and performance.
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Affiliation(s)
- Rafael Escamilla-Nunez
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M4Y 1R5, Canada; (R.E.-N.); (A.M.)
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Alexandria Michelini
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M4Y 1R5, Canada; (R.E.-N.); (A.M.)
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Jan Andrysek
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M4Y 1R5, Canada; (R.E.-N.); (A.M.)
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
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13
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Harandi VJ, Ackland DC, Haddara R, Lizama LEC, Graf M, Galea MP, Lee PVS. Gait compensatory mechanisms in unilateral transfemoral amputees. Med Eng Phys 2020; 77:95-106. [PMID: 31919013 DOI: 10.1016/j.medengphy.2019.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/04/2019] [Accepted: 11/28/2019] [Indexed: 01/14/2023]
Abstract
Individuals with unilateral transfemoral amputation depend on compensatory muscle and joint function to generate motion of the lower limbs, which can produce gait asymmetry; however, the functional role of the intact and residual limb muscles of transfemoral amputees in generating progression, support, and mediolateral balance of the body during walking is not well understood. The aim of this study was to quantify the contributions of the intact and the residual limb's contralateral muscles to body center of mass (COM) acceleration during walking in transfemoral amputees. Three-dimensional subject-specific musculoskeletal models of 6 transfemoral amputees fitted with a socket-type prosthesis were developed and used to quantify muscle forces and muscle contributions to the fore-aft, vertical, and mediolateral body COM acceleration using a pseudo-inverse ground reaction force decomposition method during over-ground walking. Anterior pelvic tilt and hip range of motion in the sagittal and frontal planes of the intact limb was significantly larger than those in the residual limb (p<0.05). The mean contributions of the intact limb hip muscles to body COM support, forward propulsion and mediolateral balance were significantly greater than those in the residual limb (p<0.05). Gluteus maximus contributed more to propulsion and support, while gluteus medius contributed more to balance than other muscles in the intact limb than the residual limb. The findings demonstrate the role of the intact limb hip musculature in compensating for reduced or absent muscles and joint function in the residual limb of transfemoral amputees during walking. The results may be useful in developing rehabilitation programs and design of prostheses to improve gait symmetry and mitigate post-operative musculoskeletal pathology.
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Affiliation(s)
| | | | - Raneem Haddara
- Department of Biomedical Engineering, University of Melbourne, Australia.
| | | | - Mark Graf
- Department of Allied Health, Royal Melbourne Hospital, Melbourne, Australia.
| | - Mary Pauline Galea
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia.
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Australia.
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14
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Alsancak S, Guner S, Celebi F. The effects of domestic mechanical knee joints on pelvic motion in transfemoral amputees. Disabil Rehabil Assist Technol 2019; 16:446-452. [PMID: 31368830 DOI: 10.1080/17483107.2019.1646822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Serap Alsancak
- Department of Prosthetics and Orthotics, Faculty Of Health Science, Ankara University, Ankara, Turkey
| | - Senem Guner
- Department of Prosthetics and Orthotics, Faculty Of Health Science, Ankara University, Ankara, Turkey
| | - Fatih Celebi
- Institute of Science, Yildirim Beyazit University, Ankara, Turkey
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15
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Development of a Mechanistic Hypothesis Linking Compensatory Biomechanics and Stepping Asymmetry during Gait of Transfemoral Amputees. Appl Bionics Biomech 2019; 2019:4769242. [PMID: 30863460 PMCID: PMC6378070 DOI: 10.1155/2019/4769242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Gait asymmetry is a common adaptation observed in lower-extremity amputees, but the underlying mechanisms that explain this gait behavior remain unclear for amputees that use above-knee prostheses. Our objective was to develop a working hypothesis to explain chronic stepping asymmetry in otherwise healthy amputees that use above-knee prostheses. Methods Two amputees (both through-knee; one with microprocessor knee, one with hydraulic knee) and fourteen control subjects participated. 3D kinematics and kinetics were acquired at normal, fast, and slow walking speeds. Data were analyzed for the push-off and collision limbs during a double support phase. We examined gait parameters to identify the stepping asymmetry then examined the external work rate (centre of mass) and internal (joint) power profiles to formulate a working hypothesis to mechanistically explain the observed stepping asymmetry. Results Stepping asymmetry at all three gait speeds in amputees was characterized by increased stance phase duration of the intact limb versus relatively normal stance phase duration for the prosthesis limb. The prosthesis limb contributed very little to positive and negative work during the double support phase of gait. To compensate, the intact leg at heel strike first provided aid to the deficient prosthetic ankle/foot during its push-off by doing positive work with the intact knee, which caused a delayed stance phase pattern. The resulting delay in toe-off of the intact limb then facilitated the energy transfer from the more robust intact push-off limb to the weaker colliding prosthesis side. This strategy was observed for both amputees. Conclusions There is a sound scientific rationale for a mechanistic hypothesis that stepping asymmetry in amputee participants is a result of a motor adaptation that is both facilitating the lower-leg trajectory enforced by the prosthesis while compensating for the lack of work done by the prosthesis, the cost of which is increased energy expenditure of the intact knee and both hips.
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16
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Bona RL, Gomeñuka NA, Storniolo JLL, Bonezi A, Biancardi CM. Self-selected walking speed in individuals with transfemoral amputation: recovery, economy and rehabilitation index. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1561941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Renata L. Bona
- Biomechanics Research and Movement Analyses Laboratory, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Natalia A. Gomeñuka
- Department of Physical Education, School of Physical Education, Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Aelgre, Brazil
| | - Jorge L. L. Storniolo
- Department of Pathophysiology and Transplantation, Laboratory of Locomotion Physiomechanics, University of Milan, Milan, Italy
| | - Artur Bonezi
- Biomechanics Research and Movement Analyses Laboratory, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Carlo M. Biancardi
- Biomechanics Research and Movement Analyses Laboratory, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
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17
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Sturk JA, Lemaire ED, Sinitski E, Dudek NL, Besemann M, Hebert JS, Baddour N. Gait differences between K3 and K4 persons with transfemoral amputation across level and non-level walking conditions. Prosthet Orthot Int 2018; 42:626-635. [PMID: 30044178 DOI: 10.1177/0309364618785724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: A transfemoral amputee's functional level can be classified from K-level 0 (lowest) to K-level 4 (highest). Knowledge of the biomechanical differences between K3 and K4 transfemoral amputation could help inform clinical professionals and researchers in amputee care and gait assessment. OBJECTIVES: Explore gait differences between K3- and K4-level transfemoral amputation across different surface conditions. STUDY DESIGN: Cross-sectional study. METHODS: Four K3 and six K4 transfemoral amputation and 10 matched able-bodied individuals walked in a virtual environment with simulated level and non-level surfaces on a self-paced treadmill. Stability measures included medial-lateral margin of stability, step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, root-mean-square of medial-lateral trunk acceleration). RESULTS: K3 walked slower than K4 with wider steps, greater root-mean-square of medial-lateral trunk acceleration, and greater medial-lateral margin of stability standard deviations, indicating their stability was further challenged. K3 participants had greater asymmetry in double support time and trunk acceleration root-mean-square in the medial-lateral direction, but similar asymmetry overall. K3 participants had larger differences from AB and in more parameters than K4, although K4 differed from AB in trunk acceleration root-mean-square in the medial-lateral direction, walking speed, and double support time standard deviations. CONCLUSION: The findings improve our understanding of K3 and K4 transfemoral amputation gait on slopes and simulated uneven surfaces. CLINICAL RELEVANCE High performing and community ambulatory transfemoral amputees cannot match the ambulatory abilities of ablebodied individuals. Understanding gait differences between these groups under conditions that challenge balance is required to develop rehabilitation protocols and prosthetic componentry targeted at improving transfemoral amputee gait and overall mobility in their chosen environment.
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Affiliation(s)
- James A Sturk
- 1 Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward D Lemaire
- 1 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,2 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emily Sinitski
- 1 Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nancy L Dudek
- 2 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Markus Besemann
- 3 Canadian Forces Health Services Centre Ottawa, Ottawa, ON, Canada
| | - Jacqueline S Hebert
- 4 University of Alberta, Edmonton, AB, Canada.,5 Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Natalie Baddour
- 6 Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
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18
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Balardina AL, Andrighettia S, Schimit VM, Cechetti F, Bonetti LV, Saccani R. Análise Cinemática Linear e Angular da Marcha em Pacientes Amputados Transfemorais Protetizados. JOURNAL OF HEALTH SCIENCES 2018. [DOI: 10.17921/2447-8938.2018v20n2p125-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A amputação leva a uma série de alterações funcionais na biomecânica corporal, gerando padrões alterados de postura e de marcha para compensar a perda do membro, sendo possível através da análise cinemática identificar as compensações e adequar o padrão de marcha. O objetivo deste estudo foi identificar as alterações cinemáticas da marcha, em pacientes protetizados em nível transfemoral, considerando os valores da normalidade e do membro não afetado. Estudo descritivo, observacional, comparativo, transversal, no qual participaram 7 indivíduos, com idade média de 59 anos, com amputação transfemoral, já protetizados. Os pacientes foram selecionados na Clínica de Fisioterapia da Universidade de Caxias do Sul. Para análise da cinemática da marcha foi utilizado o Laboratório de Análises biomecânicas do Movimento Humano da Instituição, seguindo o protocolo descrito por Laroche. Para análise de dados foi utilizada a estatística descritiva e teste t pareado e one sample (p<0,05). Observaram-se inúmeras alterações na cinemática angular e linear destes indivíduos, tanto entre membros, quanto comparando com a normalidade, porém somente a flexão de quadril quando comparada com a normalidade mostrou diferença significativa estatística (p=0,009). O estudo indicou que existem alterações importantes na cinemática da marcha em amputados transfemorais comparando à normalidade e com o membro contralateral. Estas alterações podem estar relacionadas às questões de insegurança, falta de equilíbrio, propriocepção e instabilidade no membro afetado sobre a prótese, entre outros fatores musculoesqueléticos e biomecânicos ocasionados pela mudança do membro fisiológico pelo mecânico.Palavras-chave: Marcha. Amputação. Membros Artificiais.AbstractAmputation leads to a series of functional alterations on the corporal biomechanics and these generate altered posture patterns and the march as well. This is because it is necessary to compensate the loss of a limb. The objective of the study herein was to peform akinematic analysis to identify the compensation and to adequate the march pattern as well as the kinematic alterations of the march on prosthetic limb patients regarding transfemoral issues taking into account the values of normality and the non-affected limb. It was a descriptive , observational, comparative and transversal studies in which 7 people with an average age of 59 years old participated. These people are tranfemoral amputees and they are already prosthetic-limb users. The patients were selected at the Physiotherapy Clinic of the Universidade of Caxias do Sul. The kinematic analysis took place at the Laboratory of Biomechanics and Human Movements and the protocol described by Laroche was followed. The data analysis was based on the paired t- test and on the one sample (p<0,05). Various alterations were observed on angular and linear kinematic of these persons. These alterations were noted as much among members as when comparing to normality but only the hip flexion, when compared to normality, showed significant statistics (p= 0,009). The study indicated that there are important alterations in the kinematic march in trasfemoral amputees compared to normality and compared to the contralateral limb. These alterations might be associated with insecurity, lack of balance confidence, proprioception, and instability of the limb affected on the prosthesis among other skeletal muscle system and biomechanic factors caused by the replacement of the physiological member by the mechanical one.Keywords: Gait. Amputation. Artificial Limbs.
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19
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Colyer SL, Evans M, Cosker DP, Salo AIT. A Review of the Evolution of Vision-Based Motion Analysis and the Integration of Advanced Computer Vision Methods Towards Developing a Markerless System. SPORTS MEDICINE - OPEN 2018; 4:24. [PMID: 29869300 PMCID: PMC5986692 DOI: 10.1186/s40798-018-0139-y] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The study of human movement within sports biomechanics and rehabilitation settings has made considerable progress over recent decades. However, developing a motion analysis system that collects accurate kinematic data in a timely, unobtrusive and externally valid manner remains an open challenge. MAIN BODY This narrative review considers the evolution of methods for extracting kinematic information from images, observing how technology has progressed from laborious manual approaches to optoelectronic marker-based systems. The motion analysis systems which are currently most widely used in sports biomechanics and rehabilitation do not allow kinematic data to be collected automatically without the attachment of markers, controlled conditions and/or extensive processing times. These limitations can obstruct the routine use of motion capture in normal training or rehabilitation environments, and there is a clear desire for the development of automatic markerless systems. Such technology is emerging, often driven by the needs of the entertainment industry, and utilising many of the latest trends in computer vision and machine learning. However, the accuracy and practicality of these systems has yet to be fully scrutinised, meaning such markerless systems are not currently in widespread use within biomechanics. CONCLUSIONS This review aims to introduce the key state-of-the-art in markerless motion capture research from computer vision that is likely to have a future impact in biomechanics, while considering the challenges with accuracy and robustness that are yet to be addressed.
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Affiliation(s)
- Steffi L. Colyer
- CAMERA—Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, BA2 7AY UK
- Department for Health, University of Bath, Bath, BA2 7AY UK
| | - Murray Evans
- CAMERA—Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, BA2 7AY UK
- Department of Computer Science, University of Bath, Bath, BA2 7AY UK
| | - Darren P. Cosker
- CAMERA—Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, BA2 7AY UK
- Department of Computer Science, University of Bath, Bath, BA2 7AY UK
| | - Aki I. T. Salo
- CAMERA—Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, BA2 7AY UK
- Department for Health, University of Bath, Bath, BA2 7AY UK
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20
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Bennour S, Ulrich B, Legrand T, Jolles BM, Favre J. A gait retraining system using augmented-reality to modify footprint parameters: Effects on lower-limb sagittal-plane kinematics. J Biomech 2018; 66:26-35. [DOI: 10.1016/j.jbiomech.2017.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/31/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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21
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Sharifmoradi K, Kamali M, Karimi MT. Effect of Hemipelvectomy Amputation on Kinematics and Muscle Force Generation of Lower Limb While Walking. JOURNAL OF REHABILITATION 2017. [DOI: 10.21859/jrehab-1802120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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22
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Prinsen EC, Nederhand MJ, Sveinsdóttir HS, Prins MR, van der Meer F, Koopman HFJM, Rietman JS. The influence of a user-adaptive prosthetic knee across varying walking speeds: A randomized cross-over trial. Gait Posture 2017; 51:254-260. [PMID: 27838569 DOI: 10.1016/j.gaitpost.2016.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/16/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
Previously conducted trials comparing the gait pattern of individuals with a transfemoral amputation using a user-adaptive and a non-microprocessor-controlled prosthetic knee (NMPK) found mixed and conflicting results. Few trials, however, have compared user-adaptive to non-adaptive prosthetic knees across different walking speeds. Because of the ability of variable damping, the effect of user-adaptive knees might be more pronounced at lower or higher walking speeds. Our aim was to compare the Rheo Knee II (a microprocessor-controlled prosthetic knee) with NMPKs across varying walking speeds. In addition, we studied compensatory mechanisms associated with non-optimal prosthetic knee kinematics, such as intact ankle vaulting and vertical acceleration of the pelvis. Nine persons with a transfemoral amputation or knee disarticulation were included and measured with their own NMPK and with the Rheo Knee II. Measurements were performed at three walking speeds: preferred walking speed, 70% preferred walking speed and 115% preferred walking speed. No differences on peak prosthetic knee flexion during swing were found between prosthetic knee conditions. In addition, prosthetic knee flexion increased significantly with walking speed for both prosthetic knee conditions. At 70% preferred walking speed we found that vaulting of the intact ankle was significantly decreased while walking with the Rheo Knee II compared to the NMPK condition (P=0.028). We did not find differences in peak vertical acceleration of the pelvis during initial and mid-swing of the prosthetic leg. In conclusion, comparison of walking with the Rheo Knee II to walking with a NMPK across different walking speeds showed limited differences in gait parameters.
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Affiliation(s)
- E C Prinsen
- Roessingh Research and Development P.O. Box 310, 7500 AH Enschede, The Netherlands; University of Twente MIRA research institute for Biomedical Technology and Technical Medicine Department of Biomechanical Engineering P. O. Box 217, 7500 AE Enschede, The Netherlands.
| | - M J Nederhand
- Roessingh Research and Development P.O. Box 310, 7500 AH Enschede, The Netherlands; Roessingh, Center for Rehabilitation P.O. Box 310 7500 AE Enschede, The Netherlands.
| | - H S Sveinsdóttir
- University of Twente MIRA research institute for Biomedical Technology and Technical Medicine Department of Biomechanical Engineering P. O. Box 217, 7500 AE Enschede, The Netherlands.
| | - M R Prins
- Military Rehabilitation Centre 'Aardenburg' Department Research and Development P.O. Box 185, 3940 AD Doorn, The Netherlands.
| | - F van der Meer
- Military Rehabilitation Centre 'Aardenburg' Department Research and Development P.O. Box 185, 3940 AD Doorn, The Netherlands.
| | - H F J M Koopman
- University of Twente MIRA research institute for Biomedical Technology and Technical Medicine Department of Biomechanical Engineering P. O. Box 217, 7500 AE Enschede, The Netherlands.
| | - J S Rietman
- Roessingh Research and Development P.O. Box 310, 7500 AH Enschede, The Netherlands; University of Twente MIRA research institute for Biomedical Technology and Technical Medicine Department of Biomechanical Engineering P. O. Box 217, 7500 AE Enschede, The Netherlands; Roessingh, Center for Rehabilitation P.O. Box 310 7500 AE Enschede, The Netherlands.
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23
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Highsmith MJ, Andrews CR, Millman C, Fuller A, Kahle JT, Klenow TD, Lewis KL, Bradley RC, Orriola JJ. Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review. TECHNOLOGY AND INNOVATION 2016; 18:99-113. [PMID: 28066520 DOI: 10.21300/18.2-3.2016.99] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked.
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Affiliation(s)
- M Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA
| | - Casey R Andrews
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Claire Millman
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Ashley Fuller
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Jason T Kahle
- OP Solutions, Tampa, FL, USA; Prosthetic Design + Research, Tampa, FL, USA
| | - Tyler D Klenow
- Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Katherine L Lewis
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Rachel C Bradley
- Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - John J Orriola
- Shimberg Health Sciences Library, University of South Florida, Tampa, FL, USA
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van Velzen JM, van Bennekom CAM, Polomski W, Slootman JR, van der Woude LHV, Houdijk H. Physical capacity and walking ability after lower limb amputation: a systematic review. Clin Rehabil 2016; 20:999-1016. [PMID: 17065543 DOI: 10.1177/0269215506070700] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To review the influence of physical capacity on regaining walking ability and the development of walking ability after lower limb amputation. Design: A systematic search of literature was performed. The quality of all relevant studies was evaluated according to a checklist for statistical review of general papers. Subjects: Lower limb amputees. Main measures: Physical capacity (expressed by aerobic capacity, anaerobic capacity, muscle force, flexibility and balance) and walking ability (expressed by the walking velocity and symmetry). Results: A total of 48 studies that complied with the inclusion criteria were selected. From these studies there is strong evidence for deterioration of two aspects of physical capacity (muscle strength and balance) and of two aspects of walking ability (walking velocity and symmetry) after lower limb amputation. Strong evidence was found for a relation between balance and walking ability. Conclusion: Strong evidence was only found for a relation between balance and walking ability. Evidence about a relation between other elements of physical capacity and walking ability was insufficient. Training of physical capacity as well as walking ability during rehabilitation following lower limb amputation should not be discouraged since several parameters have been shown to be reduced after amputation, although their relation to regaining walking ability and to the development of walking ability remains unclear.
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Affiliation(s)
- J M van Velzen
- Heliomare Research and Development, Wijk aan Zee, Amsterdam, The Netherlands.
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25
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Devan H, Carman A, Hendrick P, Hale L, Ribeiro DC. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review. ACTA ACUST UNITED AC 2016; 52:1-19. [PMID: 26186283 DOI: 10.1682/jrrd.2014.05.0135] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/10/2014] [Indexed: 11/05/2022]
Abstract
Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Feick E, Hamilton PR, Luis M, Corbin M, Salback NM, Torres-Moreno R, Andrysek J. A pilot study examining measures of balance and mobility in children with unilateral lower-limb amputation. Prosthet Orthot Int 2016; 40:65-74. [PMID: 25515343 DOI: 10.1177/0309364614560941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/20/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Individuals with unilateral lower-limb amputation (LLA) have altered structure and physiology of their lower limbs which impairs their balance, mobility, physical function and participation in physical activities. As part of (re)habilitation, focus is given to improving gait and balance in order to enhance overall mobility, function, self-efficacy, and independence. However, the relationships amongst body impairments and physical activity limitations remain unclear, particularly in the pediatric population. OBJECTIVE To provide an examination of the relationships among balance and mobility measures in children with unilateral lower-limb amputation and able-bodied children. STUDY DESIGN Cross-sectional prospective comparative pilot study. METHODS Spatiotemporal gait parameters and standing postural control were evaluated in children with lower-limb amputation (n = 10) and age-matched able-bodied children (n = 10) in a laboratory-based setting. Clinical tests for mobility and balance consisted of the 10-m walk test, the 6-min walk test, and the Community Balance and Mobility scale. Energy expenditure was estimated during the 6-min walk test using the Physiological Cost Index. Analysis included comparing variables between able-bodied and lower-limb amputation groups, as well as examining the correlations among them. RESULTS Walking speed, distance, and functional balance (p < 0.05) were significantly diminished in children with lower-limb amputation compared to able-bodied children. For children with lower-limb amputation, reduced energy expenditure was associated with narrower step width and more symmetrical gait; better postural control and balance were associated with faster walking speeds (p < 0.05). CONCLUSION A greater clinical understanding of gait and balance deficits in this population may help to improve rehabilitation outcomes and overall functional mobility. CLINICAL RELEVANCE Improved understanding of deficits in children with lower-limb amputation (LLA) may lead to more targeted interventions and facilitate clinical decision-making in rehabilitation settings for this population. The findings contribute to the limited literature and provide a basis to further examine suitable clinical outcome measures to be used in children with LLA.
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Affiliation(s)
- Emma Feick
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Ricardo Torres-Moreno
- University of Toronto, Toronto, ON, Canada Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Jan Andrysek
- University of Toronto, Toronto, ON, Canada Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Tang J, McGrath M, Laszczak P, Jiang L, Bader DL, Moser D, Zahedi S. Characterisation of dynamic couplings at lower limb residuum/socket interface using 3D motion capture. Med Eng Phys 2015; 37:1162-8. [DOI: 10.1016/j.medengphy.2015.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 11/24/2022]
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Shirota C, Simon AM, Kuiken TA. Transfemoral amputee recovery strategies following trips to their sound and prosthesis sides throughout swing phase. J Neuroeng Rehabil 2015; 12:79. [PMID: 26353775 PMCID: PMC4564965 DOI: 10.1186/s12984-015-0067-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/21/2015] [Indexed: 12/02/2022] Open
Abstract
Background Recovering from trips is challenging for transfemoral amputees, and attempts often result in falls. Better understanding of the effects of the sensory-motor deficits brought by amputation and the functional limitations of prosthetic devices could help guide therapy and fall prevention mechanisms in prostheses. However, how transfemoral amputees attempt to recover from trips on the sound and prosthesis sides throughout swing phase is poorly understood. Methods We tripped eight able-bodied subjects and eight unilateral transfemoral amputees wearing their prescribed prostheses. The protocol consisted of six repetitions of 6 and 4 points throughout swing phase, respectively. We compared recovery strategies in able-bodied, sound side and prosthesis side limbs. The number of kinematic recovery strategies used, when they were used throughout swing phase, and kinematic characteristics (tripped limb joint angles, bilateral trochanter height and time from foot arrest to foot strike) of each strategy were compared across limb groups. Non-parametric statistical tests with corrections for post-hoc tests were used. Results Amputees used the same recovery strategies as able-bodied subjects on both sound and prosthesis sides, although not all subjects used all strategies. Compared to able-bodied subjects, amputees used delayed-lowering strategies less often from 30-60 % of swing phase on the sound side, and from 45-60 % of swing phase on the prosthesis side. Within-strategy kinematic differences occurred across limbs; however, these differences were not consistent across all strategies. Amputee-specific recovery strategies—that are not used by control subjects—occurred following trips on both the sound and prosthesis sides in mid- to late swing. Conclusions Collectively, these results suggest that sensory input from the distal tripped leg is not necessary to trigger able-bodied trip recovery strategies. In addition, the differences between sound and prosthesis side recoveries indicate that the ability of the support leg might be more critical than that of the tripped leg when determining the response to a trip. The outcomes of this study have implications for prosthesis control, suggesting that providing correct and intuitive real-time selection of typical able-bodied recovery strategies by a prosthetic device when it is the tripped and the support limb could better enable balance recovery and avoid falls. Electronic supplementary material The online version of this article (doi:10.1186/s12984-015-0067-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camila Shirota
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA. .,Center for Bionic Medicine, Rehabilitation Institute of Chicago, 345 E. Superior St., room 1309, Chicago, IL, 60611, USA.
| | - Ann M Simon
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA. .,Center for Bionic Medicine, Rehabilitation Institute of Chicago, 345 E. Superior St., room 1309, Chicago, IL, 60611, USA.
| | - Todd A Kuiken
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA. .,Department of Surgery, Northwestern University, Chicago, IL, 60611, USA. .,Center for Bionic Medicine, Rehabilitation Institute of Chicago, 345 E. Superior St., room 1309, Chicago, IL, 60611, USA.
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29
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Prinsen EC, Nederhand MJ, Olsman J, Rietman JS. Influence of a user-adaptive prosthetic knee on quality of life, balance confidence, and measures of mobility: a randomised cross-over trial. Clin Rehabil 2014; 29:581-91. [PMID: 25288047 DOI: 10.1177/0269215514552033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the influence of a transition from a non-microprocessor controlled to the Rheo Knee(®) II on quality of life, balance confidence and measures of mobility. DESIGN Randomised crossover trial. SETTING Research department of a rehabilitation centre. SUBJECTS Persons with a transfemoral amputation or knee disarticulation (n=10). INTERVENTIONS Participants were assessed with their own non-microprocessor controlled knee and with the Rheo Knee(®) II. The low-profile Vari-Flex with EVO foot was installed in both knee conditions, followed by eight weeks of acclimatisation. The order in which knees were tested was randomised. MAIN MEASURES Prosthesis Evaluation Questionnaire with addendum, Activities-specific Balance Confidence scale, Timed "up & go" test, Timed up and down stairs test, Hill Assessment Index, Stairs Assessment Index, Standardized Walking Obstacle Course and One Leg Balance test. RESULTS Significant higher scores were found for the Rheo Knee(®) II on the Residual Limb Health subscale of the Prosthesis Evaluation Questionnaire when compared to the non-microprocessor controlled prosthetic knee (median [interquartile range] resp. 86.67 [62.21-93.08] and 68.71 [46.15-94.83]; P=0.047) In addition, participants needed significantly more steps to complete an obstacle course when walking with the Rheo Knee(®) II compared to the non-microprocessor controlled prosthetic knee (median [interquartile range] resp. 23.50 [19.92-26.25] and 22.17 [19.50-25.75]; P=0.041). On other outcome measures, no significant differences were found. CONCLUSIONS Transition towards the Rheo Knee(®) II had little effect on the studied outcome measures.
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Affiliation(s)
- Erik C Prinsen
- Roessingh Research and Development, The Netherlands Laboratory of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, The Netherlands
| | | | | | - Johan S Rietman
- Roessingh Research and Development, The Netherlands Laboratory of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, The Netherlands
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Butler K, Bowen C, Hughes AM, Torah R, Ayala I, Tudor J, Metcalf CD. A systematic review of the key factors affecting tissue viability and rehabilitation outcomes of the residual limb in lower extremity traumatic amputees. J Tissue Viability 2014; 23:81-93. [DOI: 10.1016/j.jtv.2014.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 08/07/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
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Smith JD, Ferris AE, Heise GD, Hinrichs RN, Martin PE. Oscillation and reaction board techniques for estimating inertial properties of a below-knee prosthesis. J Vis Exp 2014. [PMID: 24837164 PMCID: PMC4174037 DOI: 10.3791/50977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The purpose of this study was two-fold: (1) demonstrate a technique that can be used to directly estimate the inertial properties of a below-knee prosthesis, and (2) contrast the effects of the proposed technique and that of using intact limb inertial properties on joint kinetic estimates during walking in unilateral, transtibial amputees. An oscillation and reaction board system was validated and shown to be reliable when measuring inertial properties of known geometrical solids. When direct measurements of inertial properties of the prosthesis were used in inverse dynamics modeling of the lower extremity compared with inertial estimates based on an intact shank and foot, joint kinetics at the hip and knee were significantly lower during the swing phase of walking. Differences in joint kinetics during stance, however, were smaller than those observed during swing. Therefore, researchers focusing on the swing phase of walking should consider the impact of prosthesis inertia property estimates on study outcomes. For stance, either one of the two inertial models investigated in our study would likely lead to similar outcomes with an inverse dynamics assessment.
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Affiliation(s)
- Jeremy D Smith
- School of Sport & Exercise Science, University of Northern Colorado;
| | - Abbie E Ferris
- School of Sport & Exercise Science, University of Northern Colorado
| | - Gary D Heise
- School of Sport & Exercise Science, University of Northern Colorado
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Schwarze M, Hurschler C, Seehaus F, Correa T, Welke B. Influence of transfemoral amputation length on resulting loads at the osseointegrated prosthesis fixation during walking and falling. Clin Biomech (Bristol, Avon) 2014; 29:272-6. [PMID: 24351439 DOI: 10.1016/j.clinbiomech.2013.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transfemoral amputation is a surgical measure in which the surgeon typically conserves as much tissue and bone as possible. Osseointegrated fixation of prostheses is a promising alternative to conventional socket-based fixation. However, osseointegrated prostheses pose some risk of possible bone fracture under unexpected high-impact loading scenarios, such as a fall, and this should be protected against by a safety element. The aim of the present study was to determine the effect of amputation height on the forces and moments at the bone-prosthesis interface during normal gait and three falling scenarios. METHODS Forces and moments at four amputation heights were determined from a multi-body simulation driven by data captured from an able-bodied participant. FINDINGS In all three falling scenarios, forces were relatively independent of amputation height, while moments generally displayed considerable increases with shorter residual limb length. Peak moments ranged from 105Nm (SD 75) (most distal amputation height) to 229Nm (SD 99) (most proximal amputation height) for a "falling during gait" scenario. INTERPRETATION Our findings reveal the dependence of interface loads on amputation height in normal gait and falling. This information may lead to improved prosthesis safety elements against bending moments.
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Affiliation(s)
- Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Frank Seehaus
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Tomas Correa
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
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Bonnet X, Villa C, Fodé P, Lavaste F, Pillet H. Mechanical work performed by individual limbs of transfemoral amputees during step-to-step transitions: Effect of walking velocity. Proc Inst Mech Eng H 2013; 228:60-6. [PMID: 24288379 DOI: 10.1177/0954411913514036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The greater metabolic demand during the gait of people with a transfemoral amputation limits their autonomy and walking velocity. Major modifications of the kinematic and kinetic patterns of transfemoral amputee gait quantified using gait analysis may explain their greater energy cost. Donelan et al. proposed a method called the individual limb method to explore the relationships between the gait biomechanics and metabolic cost. In the present study, we applied this method to quantify mechanical work performed by the affected and intact limbs of transfemoral amputees. We compared a cohort of six active unilateral transfemoral amputees to a control group of six asymptomatic subjects. Compared to the control group, we found that there was significantly less mechanical work produced by the affected leg and significantly more work performed by the unaffected leg during the step-to-step transition. We also found that this mechanical work increased with walking velocity; the increase was less pronounced for the affected leg and substantial for the unaffected leg. Finally, we observed that the lesser work produced by the affected leg was linked to the increase in the hip flexion moment during the late stance phase, which is necessary for initiating knee flexion in the affected leg. It is possible to quantify the mechanical work performed during gait by people with a transfemoral amputation, using the individual limb method and conventional gait laboratory equipment. The method provides information that is useful for prosthetic fitting and rehabilitation.
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Affiliation(s)
- Xavier Bonnet
- Laboratoire de BioMécanique, Arts et Metiers ParisTech, Paris, France
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34
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Outcomes Associated with the Use of Microprocessor-Controlled Prosthetic Knees among Individuals with Unilateral Transfemoral Limb Loss. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/jpo.0000000000000000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Home-based treadmill training to improve gait performance in persons with a chronic transfemoral amputation. Arch Phys Med Rehabil 2013; 94:2440-2447. [PMID: 23954560 DOI: 10.1016/j.apmr.2013.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a home-based multiple-speed treadmill training program to improve gait performance in persons with a transfemoral amputation (TFA). DESIGN Repeated measures. SETTING Research laboratory. PARTICIPANTS Individuals with a TFA (N=8) who had undergone a unilateral amputation at least 3 years prior as a result of limb trauma or cancer. INTERVENTION Home-based treadmill walking for a total of 30 minutes a day, 3 days per week for 8 weeks. Each 30-minute training session involved 5 cycles of walking for 2 minutes at 3 speeds. MAIN OUTCOME MEASURES Participants were tested pretraining and after 4 and 8 weeks of training. The primary measures were temporal-spatial gait performance (symmetry ratios for stance phase duration and step length), physiological gait performance (energy expenditure and energy cost), and functional gait performance (self-selected walking speed [SSWS], maximum walking speed [MWS], and 2-minute walk test [2MWT]). RESULTS Eight weeks of home-based training improved temporal-spatial gait symmetry at SSWS but not at MWS. A relative interlimb increase in stance duration for the prosthetic limb and proportionally greater increases in step length for the limb taking shorter steps produced the improved symmetry. The training effect was significant for the step length symmetry ratio within the first 4 weeks of the program. Energy expenditure decreased progressively during the training with nearly 10% improvement observed across the range of walking speeds. SSWS, MWS, and 2MWT all increased by 16% to 20%. CONCLUSIONS Home-based treadmill walking is an effective method to improve gait performance in persons with TFA. The results support the application of training interventions beyond the initial rehabilitation phase, even in individuals considered highly functional.
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Roerdink M, Roeles S, van der Pas SCH, Bosboom O, Beek PJ. Evaluating asymmetry in prosthetic gait with step-length asymmetry alone is flawed. Gait Posture 2012; 35:446-51. [PMID: 22153771 DOI: 10.1016/j.gaitpost.2011.11.005] [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] [Received: 04/12/2011] [Revised: 11/01/2011] [Accepted: 11/03/2011] [Indexed: 02/02/2023]
Abstract
Prosthetic gait is often asymmetric in step length, but the direction of this asymmetry varies inconsistently across amputees. This situation is akin to that seen in stroke patients, where step-length asymmetry has been shown to be the additive result of asymmetries in trunk progression and asymmetries in forward foot placement relative to the trunk. The present study examined the validity of this notion in three trans-tibial and seven trans-femoral amputees wearing a unilateral prosthesis while walking over a walkway at a comfortable and slower-than-comfortable speed. The latter manipulation was added to examine the expectation that the magnitude of the trunk-progression asymmetry - attributable to a weaker propulsion generating capacity on the prosthetic side - would be smaller when walking slower because of the diminished propulsion demands. Step length, forward foot placement relative to the trunk, and trunk progression of prosthetic and non-prosthetic steps, as well as asymmetries therein, were quantified. The direction of step-length and forward foot placement asymmetries varied inconsistently across (but consistently within) participants. As expected, step-length asymmetry depended on the combination of asymmetries in forward foot placement and trunk progression, with a smaller contribution of trunk-progression asymmetry at slow speed. These results extend our previous finding for hemiplegic patients that an analysis of gait asymmetry in terms of step length alone is flawed to prosthetic gait, implying that knowledge of asymmetries in trunk progression and forward foot placement relative to the trunk is required to help elucidate the contribution of underlying impairments (viz. propulsion generating capacity) and adopted compensations on prosthetic gait asymmetry.
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Affiliation(s)
- Melvyn Roerdink
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands.
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37
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Andrysek J, Klejman S, Steinnagel B, Torres-Moreno R, Zabjek KF, Salbach NM, Moody K. Preliminary Evaluation of a Commercially Available Videogame System as an Adjunct Therapeutic Intervention for Improving Balance Among Children and Adolescents With Lower Limb Amputations. Arch Phys Med Rehabil 2012; 93:358-66. [PMID: 22289250 DOI: 10.1016/j.apmr.2011.08.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/17/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Jan Andrysek
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
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Wilken JM, Rodriguez KM, Brawner M, Darter BJ. Reliability and Minimal Detectible Change values for gait kinematics and kinetics in healthy adults. Gait Posture 2012; 35:301-7. [PMID: 22041096 DOI: 10.1016/j.gaitpost.2011.09.105] [Citation(s) in RCA: 232] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/10/2011] [Accepted: 09/26/2011] [Indexed: 02/02/2023]
Abstract
Computerized assessment of gait is commonly used in both research and clinical settings to quantify gait mechanics and detect change in performance. Minimal Detectable Change values have only recently been reported, are only available for patient populations, and in many cases exceed 10°. Twenty nine healthy individuals underwent two biomechanical gait assessments separated by 5.6 (SD 2.2) days, with two raters for each session. All subjects walked at a self selected pace and three controlled velocities. ICC, SEM and MDC for kinematic and kinetic measures were calculated for interrater-intrasession, intrarater-intersession and interrater-intersession. ICC values were in the good to excellent range (r>0.75) for all kinematic and kinetic variables and all comparisons. MDC values were lower than previously published data for all similar comparisons. The results of the current study suggest that reliability is good to excellent across a range of controlled walking velocities and the introduction of a second rater does not appreciably impact ICC or MDC values. In young healthy adults changes in gait kinematics of greater than approximately 5° can be identified when comparing between sessions.
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Affiliation(s)
- Jason M Wilken
- Center for the Intrepid, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.
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Prinsen EC, Nederhand MJ, Rietman JS. Adaptation Strategies of the Lower Extremities of Patients With a Transtibial or Transfemoral Amputation During Level Walking: A Systematic Review. Arch Phys Med Rehabil 2011; 92:1311-25. [DOI: 10.1016/j.apmr.2011.01.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/12/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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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: 32] [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.
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Affiliation(s)
- Laurent Frossard
- Group of Research on Adapted Physical Activities, University of Quebec, Montreal, Canada.
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Kent J, Franklyn-Miller A. Biomechanical models in the study of lower limb amputee kinematics: a review. Prosthet Orthot Int 2011; 35:124-39. [PMID: 21697196 DOI: 10.1177/0309364611407677] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Optoelectronic motion capture may provide a platform for the development of objective biomechanical outcome measures applicable to the young, active individual with lower limb loss. In order to create valid and robust tools, the modelling strategy applied must adequately represent both natural and prosthetic segments and joints. OBJECTIVES To explore existing usage of optoelectronic motion capture and modelling strategies for the analysis of amputee function. STUDY DESIGN Literature review. METHODS Systematic search of Medline (OVID) and keyword search of the Journal of Prosthetics and Orthotics. RESULTS Over 60% (n = 32) of the 51 studies extracted adopted a conventional three degree-of-freedom modelling approach. Linear segment representation (15%) and six degree-of-freedom techniques (19%) were employed in the remaining papers. Prosthetic modelling strategies were poorly reported. Landmarks were estimated from corresponding positions on the contralateral intact limb, mechanical joint centres and regression equations. No model defined the residuum and socket independently. CONCLUSIONS In the absence of a definitive solution, it is essential that the limitations of any model are understood in the development and establishment of reliable outcome measures for this population using motion capture technology. Poor reporting and a lack of consistency make comparison of results between studies and institutions impractical. CLINICAL RELEVANCE Standard modelling techniques may not consistently represent the body and prosthesis adequately to produce valid results for the analysis of function of persons with lower limb loss. Variation in modelling techniques limits the utility of findings reported in the literature. Development and application of a uniform, robust modelling strategy would benefit research and clinical practice.
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Affiliation(s)
- Jenny Kent
- Centre for Human Performance, Rehabilitation and Sports Medicine, Defence Medical Rehabilitation Centre, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK.
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Sagawa Y, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture 2011; 33:511-26. [PMID: 21392998 DOI: 10.1016/j.gaitpost.2011.02.003] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 02/03/2011] [Accepted: 02/06/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify which biomechanical and physiological parameters are the most relevant, commonly used, able to discriminate and/or have specific clinical relevance for the gait analysis of lower-limb amputees (LLA). METHODS We performed an electronic search via the PubMed, EMBASE and ISI Web of Knowledge databases from 1979 to May 2009. Two independent reviewers assessed the title and abstract of each identified study. The quality assessment of the full text was undertaken using a 13-item checklist divided into three levels: A, B, and C. RESULTS The literature search identified 584 abstracts to be considered. After applying the inclusion criteria, we reviewed the full text of a total of 89 articles. The mean article quality was 8±2. No A-level article was found; the primary reason was a negative score in blinded outcome assessment. Sixty-six articles (74%) corresponded to a B-level, and two articles (2%) corresponded to a C-level. Twenty-one articles (24%) did not acquire enough points to be assigned to any level. In this study, we present and discuss the most commonly used and most relevant 32 parameters. Many of the parameters found were not reported in enough studies or in enough detail to allow a useful evaluation. CONCLUSION This systematic review can help researchers compare, choose and develop the most appropriate gait evaluation protocol for their field of study, based on the articles with best scores on the criteria list and the relevance of specific biomechanical and physiological parameters.
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Kinematics in the Terminal Swing Phase of Unilateral Transfemoral Amputees: Microprocessor-Controlled Versus Swing-Phase Control Prosthetic Knees. Arch Phys Med Rehabil 2010; 91:919-25. [DOI: 10.1016/j.apmr.2010.01.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 12/31/2009] [Accepted: 01/21/2010] [Indexed: 11/24/2022]
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Gait symmetry and regularity in transfemoral amputees assessed by trunk accelerations. J Neuroeng Rehabil 2010; 7:4. [PMID: 20085653 PMCID: PMC2821382 DOI: 10.1186/1743-0003-7-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 01/19/2010] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to evaluate a method based on a single accelerometer for the assessment of gait symmetry and regularity in subjects wearing lower limb prostheses. Methods Ten transfemoral amputees and ten healthy control subjects were studied. For the purpose of this study, subjects wore a triaxial accelerometer on their thorax, and foot insoles. Subjects were asked to walk straight ahead for 70 m at their natural speed, and at a lower and faster speed. Indices of step and stride regularity (Ad1 and Ad2, respectively) were obtained by the autocorrelation coefficients computed from the three acceleration components. Step and stride durations were calculated from the plantar pressure data and were used to compute two reference indices (SI1 and SI2) for step and stride regularity. Results Regression analysis showed that both Ad1 well correlates with SI1 (R2 up to 0.74), and Ad2 well correlates with SI2 (R2 up to 0.52). A ROC analysis showed that Ad1 and Ad2 has generally a good sensitivity and specificity in classifying amputee's walking trial, as having a normal or a pathologic step or stride regularity as defined by means of the reference indices SI1 and SI2. In particular, the antero-posterior component of Ad1 and the vertical component of Ad2 had a sensitivity of 90.6% and 87.2%, and a specificity of 92.3% and 81.8%, respectively. Conclusions The use of a simple accelerometer, whose components can be analyzed by the autocorrelation function method, is adequate for the assessment of gait symmetry and regularity in transfemoral amputees.
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Sapin E, Goujon H, de Almeida F, Fodé P, Lavaste F. Functional gait analysis of trans-femoral amputees using two different single-axis prosthetic knees with hydraulic swing-phase control: Kinematic and kinetic comparison of two prosthetic knees. Prosthet Orthot Int 2008; 32:201-18. [PMID: 18569888 DOI: 10.1080/03093640802016639] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This paper reports a comparison of the gait patterns of trans-femoral amputees using a single-axis prosthetic knee that coordinates ankle and knee flexions (Proteor's Hydracadence system) with the gait patterns of patients using other knee joints without a knee-ankle link and the gait patterns of individuals with normal gait. The two patient groups were composed of 11 male trans-femoral amputees: six patients had the Hydracadence joint (Group 1) and five patients had other prosthetic knees (Group 2). The reference group was made up of 23 normal volunteers (Group 3). In this work, trunk, hip, knee, and ankle 3-D motion was assessed using the VICON system. Kinetic data were collected by two AMTI force plates, and the knee moment was calculated via the 3-D equilibrium equations. An original questionnaire was used to assess the participants' activity level and clinical background. The results reveal that, during stance, all knee types guaranteed security. After heel strike, the plantar flexion of the ankle enabled by the Hydracadence prosthesis seems to increase stability. During swing phase, hip and knee sagittal motion was nearly the same in both Group 1 and Group 2. By contrast, hallux and sole vertical positions were significantly higher in Group 1 than in Group 2; thus, it seems the link between the ankle joint and the knee joint makes foot clearance easier. No alteration of the lateral bending of the trunk was observed. The protocol proposed in this paper allows a functional comparison between prosthetic components by combining clinical data with objective 3-D kinematic and kinetic information. It might help to determine which prosthetic knees are best for a specific patient.
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Affiliation(s)
- E Sapin
- Laboratoire de Biomécanique ENSAM AM ParisTech, France.
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Goujon-Pillet H, Sapin E, Fodé P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait. Arch Phys Med Rehabil 2008; 89:87-94. [PMID: 18164336 DOI: 10.1016/j.apmr.2007.08.136] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 07/25/2007] [Accepted: 08/02/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify characteristics of upper-body kinematics and torque transmission to the ground during locomotion in a group of patients with transfemoral amputation as compared with a group of asymptomatic subjects; and to investigate the influence of walking velocity and residual limb length on several characteristics of upper-body motion. DESIGN Three-dimensional gait analysis with an optoelectronic device. SETTING Gait laboratory. PARTICIPANTS Twenty-seven patients with transfemoral amputation and a control group of 33 nondisabled subjects. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three-dimensional kinematics of the pelvis and the thorax and ground reaction force for amputees and control subjects. RESULTS For subjects with transfemoral amputation, it was observed that upper-body angular ranges of motion (ROMs) increased globally as walking velocity decreased. For these subjects, specific patterns of pelvic rotation and torque transmission by the lower limbs around the vertical axis were found. The counter-rotation between the pelvic and scapular girdles was reduced. This reduction proved to be linked with the decrease of walking velocity. Walking velocity also affected all the parameters describing the motion of upper body. Pelvic ROM increased with the length of the limb decreasing. CONCLUSIONS The huge differences found between subjects with and without amputation suggest that the motion of the upper body must be considered to enhance gait.
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Graham LE, Datta D, Heller B, Howitt J, Pros D. A Comparative Study of Conventional and Energy-Storing Prosthetic Feet in High-Functioning Transfemoral Amputees. Arch Phys Med Rehabil 2007; 88:801-6. [PMID: 17532907 DOI: 10.1016/j.apmr.2007.02.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the results of gait analysis, timed walking tests, and socket comfort for transfemoral amputees wearing initially a Multiflex conventional prosthetic foot and then a Vari-Flex energy-storing prosthetic foot. DESIGN Experimental crossover trial. SETTING A regional prosthetic and amputee rehabilitation tertiary referral center in a teaching hospital. PARTICIPANTS Six established unilateral transfemoral prosthetic users. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait analysis, a timed walking test, and a Prosthetic Socket Fit Comfort Score for each amputee wearing the Multiflex foot and then repeated wearing the Vari-Flex foot. RESULTS Wearing the Vari-Flex foot, our subjects walked faster in the gait lab (1.38 +/- 0.13 m/s, P < .001) and took more equal step lengths at fast speed (1.063 +/- 0.05, P < .05). They also had greater peak ankle dorsiflexion at push-off on the prosthetic side (18.3 degrees +/-4.73 degrees, P<.001) and 3 times as much power from the prosthetic ankle at push-off (1.13 +/- 0.22 W/kg, P < .001). There were no significant changes in temporal symmetry or loading of the prosthetic limb, in the timed walking test with each foot, or in the comfort score. CONCLUSIONS A transfemoral amputee who wears an energy-storing foot can have a more symmetric gait with regard to some measures of spatial symmetry, kinetics, and kinematics than one who wears a conventional foot. However, in this study important aspects such as more symmetric loading and comfort did not differ significantly between the 2 foot types.
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Affiliation(s)
- Lorraine E Graham
- Mobility and Specialised Rehabilitation Centre, Northern General Hospital, Sheffield, UK.
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Goujon H, Bonnet X, Sautreuil P, Maurisset M, Darmon L, Fode P, Lavaste F. A functional evaluation of prosthetic foot kinematics during lower-limb amputee gait. Prosthet Orthot Int 2006; 30:213-23. [PMID: 16990231 DOI: 10.1080/03093640600805134] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This paper reports on a functional evaluation of prosthetic feet based on gait analysis. The aim is to analyse prosthetic feet behaviour under loads applied during gait in order to quantify user benefits for each foot. Ten traumatic amputees (six trans-tibial and four trans-femoral) were tested using their own prosthetic foot. An original protocol is presented to calculate the forefoot kinematics together with the overall body kinematics and ground reaction forces during gait. In this work, sagittal motion of the prosthetic ankle and the forefoot, time-distance parameters and ground reaction forces were examined. It is shown that an analysis of not only trans-tibial but also trans-femoral amputees provides an insight in the performance of prosthetic feet. Symmetry and prosthetic propulsive force were proved to be mainly dependant on amputation level. In contrast, the flexion of the prosthetic forefoot and several time-distance parameters are highly influenced by foot design. Correlations show influential of foot and ankle kinematics on other parameters. These results suggest that prosthetic foot efficiency depends simultaneously on foot design and gait style. The evaluation, proposed in this article, associated to clinical examination should help to achieve the best prosthetic foot match to a patient.
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Affiliation(s)
- H Goujon
- Laboratoire de Biomécanique de l'Ensam, Paris, France.
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Detrembleur C, Vanmarsenille JM, De Cuyper F, Dierick F. Relationship between energy cost, gait speed, vertical displacement of centre of body mass and efficiency of pendulum-like mechanism in unilateral amputee gait. Gait Posture 2005; 21:333-40. [PMID: 15760750 DOI: 10.1016/j.gaitpost.2004.04.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Accepted: 04/09/2004] [Indexed: 02/02/2023]
Abstract
The energy cost of gait (C) is greater in amputee than in normal subjects. Our objective was to assess the influence of lower speed, inefficient pendulum mechanism and disturbed smoothness of centre of body mass (CM(b)) displacement on C in unilateral amputees and to have a better understanding the relationship between these variables. Twelve adult patients (six traumatic transfemoral and six vascular transtibial amputees) participated in the study. Lower limb kinematics, displacement of CM(b), mechanical work done by the muscles to move the CM(b) and the segments due to their movements relative to the CM(b), efficiency of the pendulum mechanism, and C were assessed simultaneously in the 12 amputees walking at their self-selected speed. Our results show that C depended on gait speed, and efficiency of pendulum-like mechanism of walking but did not depend on the smoothness of CM(b). The use of only a single variable to explain the extra cost in amputee gait could sometimes be misleading.
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Affiliation(s)
- Christine Detrembleur
- Rehabilitation and Physical Medicine Unit, Université catholique de Louvain, Tour Pasteur 5375, Avenue Mounier 53, B-1200 Brussels, Belgium.
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Sjödahl C, Jarnlo GB, Söderberg B, Persson BM. Pelvic motion in trans-femoral amputees in the frontal and transverse plane before and after special gait re-education. Prosthet Orthot Int 2003; 27:227-37. [PMID: 14727704 DOI: 10.1080/03093640308726686] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Using a special gait re-education programme, combining methods in physiotherapy with a psychological therapeutic approach to integrate the prosthesis with normal movements and to increase body awareness, the authors studied unilateral trans-femoral amputees aged 16-60 years with trauma or tumour as causes. In their service area they found 16 such current prosthetic users with at least 2 years of prosthetic experience and 9 who could complete the programme. Gait was measured before and after treatment and at 6 months follow-up with a three-dimensional motion analysis system and was compared to a reference group of 18 healthy volunteers of similar age. Results showed normalised gait speed and increased symmetry in step length after treatment, but reduced symmetry in pelvic motion. The reference group had a pelvic rotation of + 4 degrees both in the frontal and transverse planes. In the frontal plane, pelvic obliquity increased after treatment to a similar amplitude to the reference group, but with a different timing. Pelvic internal rotation on the amputated side increased to about 8 degrees in the beginning of stance. The amputated and the intact side before treatment were more symmetrical than afterwards and also when compared with the reference group. In spite of this, gait appeared to be more symmetrical, probably due to more efficient pelvic motion and more symmetrical upper-body movements. This was probably an effect of increased work with the intact side to compensate for the lack of power on the amputated side. These results remained at follow-up.
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Affiliation(s)
- C Sjödahl
- Department of Physical Therapy, Lund University, Sweden.
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