TPress
1.
Manz, Sabina; Seifert, Dirk; Altenburg, Bjoern; Schmalz, Thomas; Dosen, Strahinja; Gonzalez-Vargas, Jose
In: Clinical Biomechanics, Bd. 106, S. 105988, 2023, ISSN: 0268-0033.
Abstract | Links | Schlagwörter: above knee prosthesis, adult, article, C-leg, Challenger, clinical article, controlled study, data analysis software, degree of freedom, endoprosthesis, feasibility study, foot prosthesis, gait, gait analysis system, gait deviation index, Genium X3, Germany, gold standard, human, kinematics, kinetics, knee angle, knee function, knee prosthesis, leg amputation, male, microprocessor, middle aged, motion analysis system, motion sensor, SPSS, strain gauge transducer, Taleo, thigh, Triton, tyloxapol, walk test, walking speed
@article{Manz2023,
title = {Using embedded prosthesis sensors for clinical gait analyses in people with lower limb amputation: A feasibility study},
author = {Sabina Manz and Dirk Seifert and Bjoern Altenburg and Thomas Schmalz and Strahinja Dosen and Jose Gonzalez-Vargas},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2024655048&from=export},
doi = {10.1016/j.clinbiomech.2023.105988},
issn = {0268-0033},
year = {2023},
date = {2023-06-01},
journal = {Clinical Biomechanics},
volume = {106},
pages = {105988},
publisher = {Elsevier BV},
address = {J. Gonzalez-Vargas, Ottobock SE & Co. KGaA, Duderstadt, Germany},
abstract = {Background: Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. Methods: Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. Findings: The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). Interpretation: The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.},
keywords = {above knee prosthesis, adult, article, C-leg, Challenger, clinical article, controlled study, data analysis software, degree of freedom, endoprosthesis, feasibility study, foot prosthesis, gait, gait analysis system, gait deviation index, Genium X3, Germany, gold standard, human, kinematics, kinetics, knee angle, knee function, knee prosthesis, leg amputation, male, microprocessor, middle aged, motion analysis system, motion sensor, SPSS, strain gauge transducer, Taleo, thigh, Triton, tyloxapol, walk test, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. Methods: Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. Findings: The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). Interpretation: The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.
2.
Ernst, M.; Altenburg, B.; Schmalz, T.; Kannenberg, A.; Bellmann, M.
Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes Artikel
In: J. NeuroEng. Rehabil., Bd. 19, Nr. 1, 2022, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking
@article{Ernst2022,
title = {Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes},
author = {M. Ernst and B. Altenburg and T. Schmalz and A. Kannenberg and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2014862458&from=export},
doi = {10.1186/s12984-022-00983-y},
issn = {1743-0003},
year = {2022},
date = {2022-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {19},
number = {1},
address = {M. Ernst, Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany},
abstract = {Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.},
keywords = {adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking},
pubstate = {published},
tppubtype = {article}
}
Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
3.
Webster, J. B.
Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations Artikel
In: Phys. Med. Rehabil. Clin. North Am., Bd. 30, Nr. 1, S. 89–109, 2019, ISSN: 1047-9651.
Abstract | Links | Schlagwörter: analgesia, body weight gain, bone density, cardiovascular disease, clinical outcome, cumulative trauma disorder, health care management, human, injury, intermethod comparison, leg amputation, leg injury, limb prosthesis, limb salvage, long term care, low back pain, lower leg prosthesis, mental health, military personnel, obesity, osteoarthritis, osteopenia, patient care, physiotherapy, priority journal, Pro-Flex, prosthetic fitting, range of motion, rehabilitation care, review, skin irritation, traumatic amputation, traumatic brain injury, veteran, wound closure
@article{Webster2019,
title = {Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations},
author = {J. B. Webster},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2001229794&from=export},
doi = {10.1016/j.pmr.2018.08.008},
issn = {1047-9651},
year = {2019},
date = {2019-01-01},
journal = {Phys. Med. Rehabil. Clin. North Am.},
volume = {30},
number = {1},
pages = {89–109},
abstract = {Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.},
keywords = {analgesia, body weight gain, bone density, cardiovascular disease, clinical outcome, cumulative trauma disorder, health care management, human, injury, intermethod comparison, leg amputation, leg injury, limb prosthesis, limb salvage, long term care, low back pain, lower leg prosthesis, mental health, military personnel, obesity, osteoarthritis, osteopenia, patient care, physiotherapy, priority journal, Pro-Flex, prosthetic fitting, range of motion, rehabilitation care, review, skin irritation, traumatic amputation, traumatic brain injury, veteran, wound closure},
pubstate = {published},
tppubtype = {article}
}
Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.
4.
Houdijk, H.; Wezenberg, D.; Hak, L.; Cutti, A. G.
In: J. NeuroEng. Rehabil., Bd. 15, 2018, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, article, biomechanics, controlled study, energy storing and return prosthetic feet, gait, human, kinematics, leg amputation, leg prosthesis, male, mobilization, priority journal, solid ankle cushioned heel feet, step length, walking speed
@article{Houdijk2018,
title = {Energy storing and return prosthetic feet improve step length symmetry while preserving margins of stability in persons with transtibial amputation},
author = {H. Houdijk and D. Wezenberg and L. Hak and A. G. Cutti},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L623754871&from=export},
doi = {10.1186/s12984-018-0404-9},
issn = {1743-0003},
year = {2018},
date = {2018-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {15},
address = {H. Houdijk, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, Netherlands},
abstract = {Background: Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim: To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods: Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results: Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion: Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.},
keywords = {adult, article, biomechanics, controlled study, energy storing and return prosthetic feet, gait, human, kinematics, leg amputation, leg prosthesis, male, mobilization, priority journal, solid ankle cushioned heel feet, step length, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim: To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods: Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results: Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion: Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.
5.
Ernst, M.; Altenburg, B.; Bellmann, M.; Schmalz, T.
In: J. NeuroEng. Rehabil., Bd. 14, Nr. 1, 2017, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, article, autoadaptive dorsiflexion stop, controlled study, foot prosthesis, Genium, ground reaction force, human, human experiment, informed consent, joint angle, joint torque, leg amputation, male, microprocessor, microprocessor controlled prosthetic feet, musculoskeletal function, musculoskeletal system parameters, priority journal, standing, task performance, transfemoral amputation, transtibial amputation, vertical ground reaction force
@article{Ernst2017,
title = {Standing on slopes - How current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task},
author = {M. Ernst and B. Altenburg and M. Bellmann and T. Schmalz},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L619264869&from=export},
doi = {10.1186/s12984-017-0322-2},
issn = {1743-0003},
year = {2017},
date = {2017-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {14},
number = {1},
address = {M. Ernst, Research Biomechanics, CRandS, Otto Bock HealthCare GmbH, Göttingen, Germany},
abstract = {Background: Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Methods: Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Results: Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. Conclusions: A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.},
keywords = {adult, article, autoadaptive dorsiflexion stop, controlled study, foot prosthesis, Genium, ground reaction force, human, human experiment, informed consent, joint angle, joint torque, leg amputation, male, microprocessor, microprocessor controlled prosthetic feet, musculoskeletal function, musculoskeletal system parameters, priority journal, standing, task performance, transfemoral amputation, transtibial amputation, vertical ground reaction force},
pubstate = {published},
tppubtype = {article}
}
Background: Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Methods: Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Results: Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. Conclusions: A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.
2023
Manz, Sabina; Seifert, Dirk; Altenburg, Bjoern; Schmalz, Thomas; Dosen, Strahinja; Gonzalez-Vargas, Jose
In: Clinical Biomechanics, Bd. 106, S. 105988, 2023, ISSN: 0268-0033.
Abstract | Links | Schlagwörter: above knee prosthesis, adult, article, C-leg, Challenger, clinical article, controlled study, data analysis software, degree of freedom, endoprosthesis, feasibility study, foot prosthesis, gait, gait analysis system, gait deviation index, Genium X3, Germany, gold standard, human, kinematics, kinetics, knee angle, knee function, knee prosthesis, leg amputation, male, microprocessor, middle aged, motion analysis system, motion sensor, SPSS, strain gauge transducer, Taleo, thigh, Triton, tyloxapol, walk test, walking speed
@article{Manz2023,
title = {Using embedded prosthesis sensors for clinical gait analyses in people with lower limb amputation: A feasibility study},
author = {Sabina Manz and Dirk Seifert and Bjoern Altenburg and Thomas Schmalz and Strahinja Dosen and Jose Gonzalez-Vargas},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2024655048&from=export},
doi = {10.1016/j.clinbiomech.2023.105988},
issn = {0268-0033},
year = {2023},
date = {2023-06-01},
journal = {Clinical Biomechanics},
volume = {106},
pages = {105988},
publisher = {Elsevier BV},
address = {J. Gonzalez-Vargas, Ottobock SE & Co. KGaA, Duderstadt, Germany},
abstract = {Background: Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. Methods: Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. Findings: The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). Interpretation: The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.},
keywords = {above knee prosthesis, adult, article, C-leg, Challenger, clinical article, controlled study, data analysis software, degree of freedom, endoprosthesis, feasibility study, foot prosthesis, gait, gait analysis system, gait deviation index, Genium X3, Germany, gold standard, human, kinematics, kinetics, knee angle, knee function, knee prosthesis, leg amputation, male, microprocessor, middle aged, motion analysis system, motion sensor, SPSS, strain gauge transducer, Taleo, thigh, Triton, tyloxapol, walk test, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. Methods: Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. Findings: The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). Interpretation: The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.
2022
Ernst, M.; Altenburg, B.; Schmalz, T.; Kannenberg, A.; Bellmann, M.
Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes Artikel
In: J. NeuroEng. Rehabil., Bd. 19, Nr. 1, 2022, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking
@article{Ernst2022,
title = {Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes},
author = {M. Ernst and B. Altenburg and T. Schmalz and A. Kannenberg and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2014862458&from=export},
doi = {10.1186/s12984-022-00983-y},
issn = {1743-0003},
year = {2022},
date = {2022-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {19},
number = {1},
address = {M. Ernst, Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany},
abstract = {Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.},
keywords = {adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking},
pubstate = {published},
tppubtype = {article}
}
Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
2019
Webster, J. B.
Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations Artikel
In: Phys. Med. Rehabil. Clin. North Am., Bd. 30, Nr. 1, S. 89–109, 2019, ISSN: 1047-9651.
Abstract | Links | Schlagwörter: analgesia, body weight gain, bone density, cardiovascular disease, clinical outcome, cumulative trauma disorder, health care management, human, injury, intermethod comparison, leg amputation, leg injury, limb prosthesis, limb salvage, long term care, low back pain, lower leg prosthesis, mental health, military personnel, obesity, osteoarthritis, osteopenia, patient care, physiotherapy, priority journal, Pro-Flex, prosthetic fitting, range of motion, rehabilitation care, review, skin irritation, traumatic amputation, traumatic brain injury, veteran, wound closure
@article{Webster2019,
title = {Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations},
author = {J. B. Webster},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2001229794&from=export},
doi = {10.1016/j.pmr.2018.08.008},
issn = {1047-9651},
year = {2019},
date = {2019-01-01},
journal = {Phys. Med. Rehabil. Clin. North Am.},
volume = {30},
number = {1},
pages = {89–109},
abstract = {Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.},
keywords = {analgesia, body weight gain, bone density, cardiovascular disease, clinical outcome, cumulative trauma disorder, health care management, human, injury, intermethod comparison, leg amputation, leg injury, limb prosthesis, limb salvage, long term care, low back pain, lower leg prosthesis, mental health, military personnel, obesity, osteoarthritis, osteopenia, patient care, physiotherapy, priority journal, Pro-Flex, prosthetic fitting, range of motion, rehabilitation care, review, skin irritation, traumatic amputation, traumatic brain injury, veteran, wound closure},
pubstate = {published},
tppubtype = {article}
}
Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.
2018
Houdijk, H.; Wezenberg, D.; Hak, L.; Cutti, A. G.
In: J. NeuroEng. Rehabil., Bd. 15, 2018, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, article, biomechanics, controlled study, energy storing and return prosthetic feet, gait, human, kinematics, leg amputation, leg prosthesis, male, mobilization, priority journal, solid ankle cushioned heel feet, step length, walking speed
@article{Houdijk2018,
title = {Energy storing and return prosthetic feet improve step length symmetry while preserving margins of stability in persons with transtibial amputation},
author = {H. Houdijk and D. Wezenberg and L. Hak and A. G. Cutti},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L623754871&from=export},
doi = {10.1186/s12984-018-0404-9},
issn = {1743-0003},
year = {2018},
date = {2018-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {15},
address = {H. Houdijk, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, Netherlands},
abstract = {Background: Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim: To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods: Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results: Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion: Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.},
keywords = {adult, article, biomechanics, controlled study, energy storing and return prosthetic feet, gait, human, kinematics, leg amputation, leg prosthesis, male, mobilization, priority journal, solid ankle cushioned heel feet, step length, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim: To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods: Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results: Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion: Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.
2017
Ernst, M.; Altenburg, B.; Bellmann, M.; Schmalz, T.
In: J. NeuroEng. Rehabil., Bd. 14, Nr. 1, 2017, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, article, autoadaptive dorsiflexion stop, controlled study, foot prosthesis, Genium, ground reaction force, human, human experiment, informed consent, joint angle, joint torque, leg amputation, male, microprocessor, microprocessor controlled prosthetic feet, musculoskeletal function, musculoskeletal system parameters, priority journal, standing, task performance, transfemoral amputation, transtibial amputation, vertical ground reaction force
@article{Ernst2017,
title = {Standing on slopes - How current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task},
author = {M. Ernst and B. Altenburg and M. Bellmann and T. Schmalz},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L619264869&from=export},
doi = {10.1186/s12984-017-0322-2},
issn = {1743-0003},
year = {2017},
date = {2017-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {14},
number = {1},
address = {M. Ernst, Research Biomechanics, CRandS, Otto Bock HealthCare GmbH, Göttingen, Germany},
abstract = {Background: Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Methods: Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Results: Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. Conclusions: A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.},
keywords = {adult, article, autoadaptive dorsiflexion stop, controlled study, foot prosthesis, Genium, ground reaction force, human, human experiment, informed consent, joint angle, joint torque, leg amputation, male, microprocessor, microprocessor controlled prosthetic feet, musculoskeletal function, musculoskeletal system parameters, priority journal, standing, task performance, transfemoral amputation, transtibial amputation, vertical ground reaction force},
pubstate = {published},
tppubtype = {article}
}
Background: Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Methods: Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Results: Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. Conclusions: A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.
2023
Manz, Sabina; Seifert, Dirk; Altenburg, Bjoern; Schmalz, Thomas; Dosen, Strahinja; Gonzalez-Vargas, Jose
In: Clinical Biomechanics, Bd. 106, S. 105988, 2023, ISSN: 0268-0033.
@article{Manz2023,
title = {Using embedded prosthesis sensors for clinical gait analyses in people with lower limb amputation: A feasibility study},
author = {Sabina Manz and Dirk Seifert and Bjoern Altenburg and Thomas Schmalz and Strahinja Dosen and Jose Gonzalez-Vargas},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2024655048&from=export},
doi = {10.1016/j.clinbiomech.2023.105988},
issn = {0268-0033},
year = {2023},
date = {2023-06-01},
journal = {Clinical Biomechanics},
volume = {106},
pages = {105988},
publisher = {Elsevier BV},
address = {J. Gonzalez-Vargas, Ottobock SE & Co. KGaA, Duderstadt, Germany},
abstract = {Background: Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. Methods: Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. Findings: The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). Interpretation: The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. Methods: Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. Findings: The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). Interpretation: The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.
2022
Ernst, M.; Altenburg, B.; Schmalz, T.; Kannenberg, A.; Bellmann, M.
Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes Artikel
In: J. NeuroEng. Rehabil., Bd. 19, Nr. 1, 2022, ISSN: 1743-0003.
@article{Ernst2022,
title = {Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes},
author = {M. Ernst and B. Altenburg and T. Schmalz and A. Kannenberg and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2014862458&from=export},
doi = {10.1186/s12984-022-00983-y},
issn = {1743-0003},
year = {2022},
date = {2022-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {19},
number = {1},
address = {M. Ernst, Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany},
abstract = {Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
2019
Webster, J. B.
Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations Artikel
In: Phys. Med. Rehabil. Clin. North Am., Bd. 30, Nr. 1, S. 89–109, 2019, ISSN: 1047-9651.
@article{Webster2019,
title = {Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations},
author = {J. B. Webster},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2001229794&from=export},
doi = {10.1016/j.pmr.2018.08.008},
issn = {1047-9651},
year = {2019},
date = {2019-01-01},
journal = {Phys. Med. Rehabil. Clin. North Am.},
volume = {30},
number = {1},
pages = {89–109},
abstract = {Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.
2018
Houdijk, H.; Wezenberg, D.; Hak, L.; Cutti, A. G.
In: J. NeuroEng. Rehabil., Bd. 15, 2018, ISSN: 1743-0003.
@article{Houdijk2018,
title = {Energy storing and return prosthetic feet improve step length symmetry while preserving margins of stability in persons with transtibial amputation},
author = {H. Houdijk and D. Wezenberg and L. Hak and A. G. Cutti},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L623754871&from=export},
doi = {10.1186/s12984-018-0404-9},
issn = {1743-0003},
year = {2018},
date = {2018-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {15},
address = {H. Houdijk, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, Amsterdam, Netherlands},
abstract = {Background: Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim: To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods: Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results: Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion: Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim: To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods: Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results: Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion: Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.
2017
Ernst, M.; Altenburg, B.; Bellmann, M.; Schmalz, T.
In: J. NeuroEng. Rehabil., Bd. 14, Nr. 1, 2017, ISSN: 1743-0003.
@article{Ernst2017,
title = {Standing on slopes - How current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task},
author = {M. Ernst and B. Altenburg and M. Bellmann and T. Schmalz},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L619264869&from=export},
doi = {10.1186/s12984-017-0322-2},
issn = {1743-0003},
year = {2017},
date = {2017-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {14},
number = {1},
address = {M. Ernst, Research Biomechanics, CRandS, Otto Bock HealthCare GmbH, Göttingen, Germany},
abstract = {Background: Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Methods: Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Results: Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. Conclusions: A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Methods: Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Results: Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. Conclusions: A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.
Shimizu, Y.; Mutsuzaki, H.; Maezawa, T.; Idei, Y.; Takao, K.; Takeuchi, R.; Onishi, S.; Hada, Y.; Yamazaki, M.; Wadano, Y.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 5, S. 522–526, 2017, ISSN: 0309-3646.
@article{Shimizu2017,
title = {Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury: a case report},
author = {Y. Shimizu and H. Mutsuzaki and T. Maezawa and Y. Idei and K. Takao and R. Takeuchi and S. Onishi and Y. Hada and M. Yamazaki and Y. Wadano},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L618507994&from=export},
doi = {10.1177/0309364616682384},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {5},
pages = {522–526},
address = {Y. Shimizu, Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan},
abstract = {Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.
2014
Kistenberg, R. S.
Prosthetic choices for people with leg and arm amputations Artikel
In: Phys. Med. Rehabil. Clin. North Am., Bd. 25, Nr. 1, S. 93–115, 2014, ISSN: 1558-1381.
@article{Kistenberg2014,
title = {Prosthetic choices for people with leg and arm amputations},
author = {R. S. Kistenberg},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L370343297&from=export},
doi = {10.1016/j.pmr.2013.10.001},
issn = {1558-1381},
year = {2014},
date = {2014-01-01},
journal = {Phys. Med. Rehabil. Clin. North Am.},
volume = {25},
number = {1},
pages = {93–115},
address = {R.S. Kistenberg, Georgia Institute of Technology, School of Applied Physiology, 555 14th Street, Atlanta, GA 30318, United States},
abstract = {New technology and materials have advanced prosthetic designs to enable people who rely on artificial limbs to achieve feats never dreamed before. However, the latest and the greatest technology is not appropriate for everyone. The aim of this article is to present contemporary options that are available for people who rely on artificial limbs to enhance their quality of life for mobility and independence. © 2014 Elsevier Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
New technology and materials have advanced prosthetic designs to enable people who rely on artificial limbs to achieve feats never dreamed before. However, the latest and the greatest technology is not appropriate for everyone. The aim of this article is to present contemporary options that are available for people who rely on artificial limbs to enhance their quality of life for mobility and independence. © 2014 Elsevier Inc.
Chitragari, G.; Mahler, D. B.; Sumpio, B. J.; Blume, P. A.; Sumpio, B. E.
Prosthetic options available for the diabetic lower limb amputee Artikel
In: Clin. Podiatr. Med. Surg., Bd. 31, Nr. 1, S. 174–185, 2014, ISSN: 1558-2302.
@article{Chitragari2014,
title = {Prosthetic options available for the diabetic lower limb amputee},
author = {G. Chitragari and D. B. Mahler and B. J. Sumpio and P. A. Blume and B. E. Sumpio},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L370343216&from=export},
doi = {10.1016/j.cpm.2013.09.008},
issn = {1558-2302},
year = {2014},
date = {2014-01-01},
journal = {Clin. Podiatr. Med. Surg.},
volume = {31},
number = {1},
pages = {174–185},
address = {B.E. Sumpio, Yale University School of Medicine, 333 Cedar Street, BB 204, New Haven, CT 06520-8062, United States},
abstract = {Although the rate of lower limb amputation in patients with diabetes is decreasing, amputation still remains a major complication of diabetes. Prosthetics have been long used to help amputees ambulate. The last decade has seen many advances in prostheses with the enhanced understanding of the mechanics of ambulation and improved use of technology. This review describes the different types of prosthetic options available for below knee, ankle, and foot amputees, emphasizing the latest advances in prosthetic design. © 2014 Elsevier Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Although the rate of lower limb amputation in patients with diabetes is decreasing, amputation still remains a major complication of diabetes. Prosthetics have been long used to help amputees ambulate. The last decade has seen many advances in prostheses with the enhanced understanding of the mechanics of ambulation and improved use of technology. This review describes the different types of prosthetic options available for below knee, ankle, and foot amputees, emphasizing the latest advances in prosthetic design. © 2014 Elsevier Inc.
2012
Portnoy, S.; Kristal, A.; Gefen, A.; Siev-Ner, I.
In: Gait Posture, Bd. 35, Nr. 1, S. 121–125, 2012, ISSN: 1879-2219.
@article{Portnoy2012,
title = {Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: Hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet},
author = {S. Portnoy and A. Kristal and A. Gefen and I. Siev-Ner},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L51635905&from=export},
doi = {10.1016/j.gaitpost.2011.08.021},
issn = {1879-2219},
year = {2012},
date = {2012-01-01},
journal = {Gait Posture},
volume = {35},
number = {1},
pages = {121–125},
address = {S. Portnoy, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel},
abstract = {The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (p<. 0.01) in peak internal stresses and in the loading rate of the amputated limb, while walking with the hydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ∼2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain. © 2011 Elsevier B.V.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (p<. 0.01) in peak internal stresses and in the loading rate of the amputated limb, while walking with the hydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ∼2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain. © 2011 Elsevier B.V.