TPress
1.
Trinler, U.; Heitzmann, D. W. W.; Hitzeroth, S.; Alimusaj, M.; Rehg, M.; Hogan, A.
In: Prosthet. Orthot. Int., Bd. 47, Nr. 1, S. 94–100, 2023, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adult, amputation, article, biomechanics, carbon fiber, clinical article, cohort analysis, ComfyStep, female, foot prosthesis, ground reaction force, human, kinematics, kinetics, knee function, L.A.S.A.R. Posture device, male, medical device, post hoc analysis, prospective study, range of motion, statistical analysis, three dimensional printing, transtibial amputation
@article{Trinler2023,
title = {Biomechanical comparison of a 3D-printed prosthetic foot with conventional feet in people with transtibial amputation: A prospective cohort study},
author = {U. Trinler and D. W. W. Heitzmann and S. Hitzeroth and M. Alimusaj and M. Rehg and A. Hogan},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2022874959&from=export},
doi = {10.1097/PXR.0000000000000180},
issn = {0309-3646},
year = {2023},
date = {2023-08-01},
journal = {Prosthet. Orthot. Int.},
volume = {47},
number = {1},
pages = {94–100},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
address = {U. Trinler, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, Ludwigshafen, Germany},
abstract = {Introduction: The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Methods: Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. Results: The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. Conclusion: In principle, 3D-printed feet have advantages over conventional “off the shelf” feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.},
keywords = {adult, amputation, article, biomechanics, carbon fiber, clinical article, cohort analysis, ComfyStep, female, foot prosthesis, ground reaction force, human, kinematics, kinetics, knee function, L.A.S.A.R. Posture device, male, medical device, post hoc analysis, prospective study, range of motion, statistical analysis, three dimensional printing, transtibial amputation},
pubstate = {published},
tppubtype = {article}
}
Introduction: The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Methods: Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. Results: The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. Conclusion: In principle, 3D-printed feet have advantages over conventional “off the shelf” feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.
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.
Waterval, N. F. J.; Brehm, M. -A.; Harlaar, J.; Nollet, F.
In: J. NeuroEng. Rehabil., Bd. 18, Nr. 1, 2021, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, ankle foot orthosis, article, body weight, Carbon Ankle7, clinical effectiveness, correlational study, dorsal leaf spring ankle foot orthosis, energy cost, female, human, male, middle aged, muscle strength, muscle weakness, range of motion, risk factor, triceps surae muscle, walking speed
@article{Waterval2021,
title = {Individual stiffness optimization of dorsal leaf spring ankle-foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations},
author = {N. F. J. Waterval and M. -A. Brehm and J. Harlaar and F. Nollet},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2012344314&from=export},
doi = {10.1186/s12984-021-00890-8},
issn = {1743-0003},
year = {2021},
date = {2021-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {18},
number = {1},
address = {N.F.J. Waterval, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands},
abstract = {Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s},
keywords = {adult, ankle foot orthosis, article, body weight, Carbon Ankle7, clinical effectiveness, correlational study, dorsal leaf spring ankle foot orthosis, energy cost, female, human, male, middle aged, muscle strength, muscle weakness, range of motion, risk factor, triceps surae muscle, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s
4.
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.
5.
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.
Abstract | Links | Schlagwörter: adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing
@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 = {adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing},
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.
2023
Trinler, U.; Heitzmann, D. W. W.; Hitzeroth, S.; Alimusaj, M.; Rehg, M.; Hogan, A.
In: Prosthet. Orthot. Int., Bd. 47, Nr. 1, S. 94–100, 2023, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adult, amputation, article, biomechanics, carbon fiber, clinical article, cohort analysis, ComfyStep, female, foot prosthesis, ground reaction force, human, kinematics, kinetics, knee function, L.A.S.A.R. Posture device, male, medical device, post hoc analysis, prospective study, range of motion, statistical analysis, three dimensional printing, transtibial amputation
@article{Trinler2023,
title = {Biomechanical comparison of a 3D-printed prosthetic foot with conventional feet in people with transtibial amputation: A prospective cohort study},
author = {U. Trinler and D. W. W. Heitzmann and S. Hitzeroth and M. Alimusaj and M. Rehg and A. Hogan},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2022874959&from=export},
doi = {10.1097/PXR.0000000000000180},
issn = {0309-3646},
year = {2023},
date = {2023-08-01},
journal = {Prosthet. Orthot. Int.},
volume = {47},
number = {1},
pages = {94–100},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
address = {U. Trinler, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, Ludwigshafen, Germany},
abstract = {Introduction: The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Methods: Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. Results: The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. Conclusion: In principle, 3D-printed feet have advantages over conventional “off the shelf” feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.},
keywords = {adult, amputation, article, biomechanics, carbon fiber, clinical article, cohort analysis, ComfyStep, female, foot prosthesis, ground reaction force, human, kinematics, kinetics, knee function, L.A.S.A.R. Posture device, male, medical device, post hoc analysis, prospective study, range of motion, statistical analysis, three dimensional printing, transtibial amputation},
pubstate = {published},
tppubtype = {article}
}
Introduction: The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Methods: Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. Results: The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. Conclusion: In principle, 3D-printed feet have advantages over conventional “off the shelf” feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.
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.
2021
Waterval, N. F. J.; Brehm, M. -A.; Harlaar, J.; Nollet, F.
In: J. NeuroEng. Rehabil., Bd. 18, Nr. 1, 2021, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, ankle foot orthosis, article, body weight, Carbon Ankle7, clinical effectiveness, correlational study, dorsal leaf spring ankle foot orthosis, energy cost, female, human, male, middle aged, muscle strength, muscle weakness, range of motion, risk factor, triceps surae muscle, walking speed
@article{Waterval2021,
title = {Individual stiffness optimization of dorsal leaf spring ankle-foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations},
author = {N. F. J. Waterval and M. -A. Brehm and J. Harlaar and F. Nollet},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2012344314&from=export},
doi = {10.1186/s12984-021-00890-8},
issn = {1743-0003},
year = {2021},
date = {2021-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {18},
number = {1},
address = {N.F.J. Waterval, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands},
abstract = {Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s},
keywords = {adult, ankle foot orthosis, article, body weight, Carbon Ankle7, clinical effectiveness, correlational study, dorsal leaf spring ankle foot orthosis, energy cost, female, human, male, middle aged, muscle strength, muscle weakness, range of motion, risk factor, triceps surae muscle, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s
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.
2017
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.
Abstract | Links | Schlagwörter: adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing
@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 = {adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing},
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.
2023
Trinler, U.; Heitzmann, D. W. W.; Hitzeroth, S.; Alimusaj, M.; Rehg, M.; Hogan, A.
In: Prosthet. Orthot. Int., Bd. 47, Nr. 1, S. 94–100, 2023, ISSN: 0309-3646.
@article{Trinler2023,
title = {Biomechanical comparison of a 3D-printed prosthetic foot with conventional feet in people with transtibial amputation: A prospective cohort study},
author = {U. Trinler and D. W. W. Heitzmann and S. Hitzeroth and M. Alimusaj and M. Rehg and A. Hogan},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2022874959&from=export},
doi = {10.1097/PXR.0000000000000180},
issn = {0309-3646},
year = {2023},
date = {2023-08-01},
journal = {Prosthet. Orthot. Int.},
volume = {47},
number = {1},
pages = {94–100},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
address = {U. Trinler, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, Ludwigshafen, Germany},
abstract = {Introduction: The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Methods: Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. Results: The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. Conclusion: In principle, 3D-printed feet have advantages over conventional “off the shelf” feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction: The method of 3D printing is increasingly gaining utilization in clinical applications and may support prosthetic fitting. The aim was to compare biomechanical outcomes of people with a transtibial amputation using a novel, individualizable, 3D-printed prosthetic foot (ComfyStep, Mecuris) with two conventional, widely used prosthetic feet during level ground walking using a 3D motion analysis system. Methods: Ten individuals with an unilateral transtibial amputation were fitted with 3 prosthetic feet (ComfyStep, Assure/Össur, DynamicMotion/Ottobock) using their current, well-fitting socket. They had at least 1 week of familiarization for each foot before gait analyses were conducted. Kinematics and kinetics as well as roll over shape (ROS) length and radius were calculated and compared between feet. Results: The sound side gait parameters of the participants were comparable when using different feet. However, there were differences on the affected side. The statistical analysis revealed that the 3D-printed foot differed significantly compared with the conventional feet in the following aspects: reduced range of motion, increased plantar flexion moment, reduced plantar flexion power, larger ROS radius, less favorable energy ratio, and higher overall stiffness. Conclusion: In principle, 3D-printed feet have advantages over conventional “off the shelf” feet, as their biomechanical characteristics could be adjusted more in detail according to the patient needs. Although, differences between conventional feet and the ComfyStep were shown. Whether these differences have a negative clinically relevant effect remains unclear. However, results suggest that commercially available 3D-printed feet should incorporate systematically better adjustments, for example, for stiffness, to enhance prosthetic performance.
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.
2021
Waterval, N. F. J.; Brehm, M. -A.; Harlaar, J.; Nollet, F.
In: J. NeuroEng. Rehabil., Bd. 18, Nr. 1, 2021, ISSN: 1743-0003.
@article{Waterval2021,
title = {Individual stiffness optimization of dorsal leaf spring ankle-foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations},
author = {N. F. J. Waterval and M. -A. Brehm and J. Harlaar and F. Nollet},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2012344314&from=export},
doi = {10.1186/s12984-021-00890-8},
issn = {1743-0003},
year = {2021},
date = {2021-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {18},
number = {1},
address = {N.F.J. Waterval, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands},
abstract = {Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s
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.
2017
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.
2016
Williams, M. R.; D'Andrea, S.; Herr, H. M.
Impact on gait biomechanics of using an active variable impedance prosthetic knee Artikel
In: J. NeuroEng. Rehabil., Bd. 13, Nr. 1, 2016, ISSN: 1743-0003.
@article{Williams2016,
title = {Impact on gait biomechanics of using an active variable impedance prosthetic knee},
author = {M. R. Williams and S. D'Andrea and H. M. Herr},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L610660431&from=export},
doi = {10.1186/s12984-016-0159-0},
issn = {1743-0003},
year = {2016},
date = {2016-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {13},
number = {1},
address = {M.R. Williams, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States},
abstract = {Background: An above knee amputation can have a significant impact on gait, with substantial deviations in inter-leg symmetry, step length, hip exertion and upper body involvement even when using a current clinical standard of care prosthesis. These differences can produce gait that is less efficient and less comfortable, resulting in slower and shorter distance walking, particularly with long term use. Methods: A robotic variable impedance prosthetic knee (VI Knee) was tested with five individuals (N = 5) with unilateral amputation above the knee at fixed speeds both above and below their normal walking speed. Subject gait was measured as they walked along an instrumented walkway via optical motion capture and force plates in the floor. Each subject's gait while using the VI Knee was compared to that while using their standard of care knee (OttoBock C-Leg). Results: Significant differences (p < 0.05) in walking between the standard of care and variable impedance devices were seen in step length and hip range of motion symmetries, hip extension moment, knee power and torso lean angle. While using the VI Knee, several subjects demonstrated statistically significant improvements in gait, particularly in increased hip range of motion symmetry between affected and intact sides, greater prosthesis knee power and in reducing upper body involvement in the walking task by decreasing forward and affected side lean and reducing the pelvis-torso twist coupling. These changes to torso posture during gait also resulted in increased terminal stance hip flexion moment across subjects. Detriments to gait were also observed in that some subjects exhibited decreased step length symmetry while using the VI Knee compared to the C-Leg. Conclusions: The knee tested represents the potential to improve gait biomechanics and reduce upper body involvement in persons with above knee amputation compared to current standard of care devices. While using the VI Knee, subjects demonstrated statistically significant improvements in several aspects of gait though some were worsened while using the device. It is possible that these negative effects may be mitigated through longer term training and experience with the VI Knee. Given the demonstrated benefits and the potential to reduce or eliminate detriments through training, using a powered device like the VI Knee, particularly over an extended period of time, may help to improve walking performance and comfort.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: An above knee amputation can have a significant impact on gait, with substantial deviations in inter-leg symmetry, step length, hip exertion and upper body involvement even when using a current clinical standard of care prosthesis. These differences can produce gait that is less efficient and less comfortable, resulting in slower and shorter distance walking, particularly with long term use. Methods: A robotic variable impedance prosthetic knee (VI Knee) was tested with five individuals (N = 5) with unilateral amputation above the knee at fixed speeds both above and below their normal walking speed. Subject gait was measured as they walked along an instrumented walkway via optical motion capture and force plates in the floor. Each subject's gait while using the VI Knee was compared to that while using their standard of care knee (OttoBock C-Leg). Results: Significant differences (p < 0.05) in walking between the standard of care and variable impedance devices were seen in step length and hip range of motion symmetries, hip extension moment, knee power and torso lean angle. While using the VI Knee, several subjects demonstrated statistically significant improvements in gait, particularly in increased hip range of motion symmetry between affected and intact sides, greater prosthesis knee power and in reducing upper body involvement in the walking task by decreasing forward and affected side lean and reducing the pelvis-torso twist coupling. These changes to torso posture during gait also resulted in increased terminal stance hip flexion moment across subjects. Detriments to gait were also observed in that some subjects exhibited decreased step length symmetry while using the VI Knee compared to the C-Leg. Conclusions: The knee tested represents the potential to improve gait biomechanics and reduce upper body involvement in persons with above knee amputation compared to current standard of care devices. While using the VI Knee, subjects demonstrated statistically significant improvements in several aspects of gait though some were worsened while using the device. It is possible that these negative effects may be mitigated through longer term training and experience with the VI Knee. Given the demonstrated benefits and the potential to reduce or eliminate detriments through training, using a powered device like the VI Knee, particularly over an extended period of time, may help to improve walking performance and comfort.