TPress
1.
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.
2.
Pröbsting, E.; Kannenberg, A.; Zacharias, B.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 1, S. 65–77, 2017, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adult, aged, ankle foot orthosis, article, C Brace, clinical article, daily life activity, device safety, E MAG Active, female, follow up, Free Walk, Horton SCO, human, KAFO SPL, knee-ankle-foot orthosis, male, microprocessor stance and swing control orthosis, middle aged, NEURO MATIC, patient-reported outcome, standing, very elderly, walking
@article{Proebsting2017,
title = {Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis},
author = {E. Pröbsting and A. Kannenberg and B. Zacharias},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L614321344&from=export},
doi = {10.1177/0309364616637954},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {1},
pages = {65–77},
address = {E. Pröbsting, Otto Bock HealthCare GmbH, Department Clinical Research and Services, Goettingen, Germany},
abstract = {Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.},
keywords = {adult, aged, ankle foot orthosis, article, C Brace, clinical article, daily life activity, device safety, E MAG Active, female, follow up, Free Walk, Horton SCO, human, KAFO SPL, knee-ankle-foot orthosis, male, microprocessor stance and swing control orthosis, middle aged, NEURO MATIC, patient-reported outcome, standing, very elderly, walking},
pubstate = {published},
tppubtype = {article}
}
Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.
3.
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.
Abstract | Links | Schlagwörter: above knee amputation, adult, aged, article, biomechanics, body position, C-leg, clinical article, College Park Trustep, controlled study, female, foot prosthesis, gait, gait biomechanics, hip, hip extension moment, human, knee power, knee prosthesis, Low Profile Vari-Flex, male, musculoskeletal system parameters, priority journal, range of motion, robotic variable impedance prosthetic knee, step length symmetry, torso lean angle, Triton, VI Knee, walking speed
@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 = {above knee amputation, adult, aged, article, biomechanics, body position, C-leg, clinical article, College Park Trustep, controlled study, female, foot prosthesis, gait, gait biomechanics, hip, hip extension moment, human, knee power, knee prosthesis, Low Profile Vari-Flex, male, musculoskeletal system parameters, priority journal, range of motion, robotic variable impedance prosthetic knee, step length symmetry, torso lean angle, Triton, VI Knee, walking speed},
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.
4.
Ludwigs, E.; Bellmann, M.; Schmalz, T.; Blumentritt, S.
Biomechanical differences between two exoprosthetic hip joint systems during level walking Artikel
In: Prosthet. Orthot. Int., Bd. 34, Nr. 4, S. 449–460, 2010, ISSN: 1746-1553.
Abstract | Links | Schlagwörter: 7E7 hip joint, adult, aged, article, biomechanics, C-leg, C-walk, clinical article, devices, energy consumption, female, gait, Helix3D Hip Joint, hip prosthesis, human, kinematics, knee function, male, swing phase, walking
@article{Ludwigs2010,
title = {Biomechanical differences between two exoprosthetic hip joint systems during level walking},
author = {E. Ludwigs and M. Bellmann and T. Schmalz and S. Blumentritt},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L360015209&from=export},
doi = {10.3109/03093646.2010.499551},
issn = {1746-1553},
year = {2010},
date = {2010-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {34},
number = {4},
pages = {449–460},
address = {E. Ludwigs, Research Department, Otto Bock HealthCare GmbH, Hermann-Rein-Str. 2a, Gttingen, 37075, Germany},
abstract = {Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.},
keywords = {7E7 hip joint, adult, aged, article, biomechanics, C-leg, C-walk, clinical article, devices, energy consumption, female, gait, Helix3D Hip Joint, hip prosthesis, human, kinematics, knee function, male, swing phase, walking},
pubstate = {published},
tppubtype = {article}
}
Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.
5.
Wit, D. C. M.; Buurke, J. H.; Nijlant, J. M. M.; IJzerman, M. J.; Hermens, H. J.
In: Clin. Rehabil., Bd. 18, Nr. 5, S. 550–557, 2004, ISSN: 0269-2155.
Abstract | Links | Schlagwörter: adult, aged, article, Camp, cerebrovascular accident, chronic disease, climbing, clinical article, clinical trial, controlled clinical trial, controlled study, crossover procedure, Distrac, Dynafo, female, gait disorder, human, male, motivation, motor performance, orthosis, Ottobock, randomized controlled trial, scoring system, self esteem, standing, statistical analysis, task performance, walking speed
@article{Wit2004,
title = {The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: A randomized controlled trial},
author = {D. C. M. Wit and J. H. Buurke and J. M. M. Nijlant and M. J. IJzerman and H. J. Hermens},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L39076880&from=export},
doi = {10.1191/0269215504cr770oa},
issn = {0269-2155},
year = {2004},
date = {2004-01-01},
journal = {Clin. Rehabil.},
volume = {18},
number = {5},
pages = {550–557},
address = {D.C.M. de Wit, Roessingh Research and Development, Roessinghbleekweg 33B, 7522 AH Enschede, Netherlands},
abstract = {Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFC) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO. © Arnold 2004.},
keywords = {adult, aged, article, Camp, cerebrovascular accident, chronic disease, climbing, clinical article, clinical trial, controlled clinical trial, controlled study, crossover procedure, Distrac, Dynafo, female, gait disorder, human, male, motivation, motor performance, orthosis, Ottobock, randomized controlled trial, scoring system, self esteem, standing, statistical analysis, task performance, walking speed},
pubstate = {published},
tppubtype = {article}
}
Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFC) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO. © Arnold 2004.
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.
2017
Pröbsting, E.; Kannenberg, A.; Zacharias, B.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 1, S. 65–77, 2017, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adult, aged, ankle foot orthosis, article, C Brace, clinical article, daily life activity, device safety, E MAG Active, female, follow up, Free Walk, Horton SCO, human, KAFO SPL, knee-ankle-foot orthosis, male, microprocessor stance and swing control orthosis, middle aged, NEURO MATIC, patient-reported outcome, standing, very elderly, walking
@article{Proebsting2017,
title = {Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis},
author = {E. Pröbsting and A. Kannenberg and B. Zacharias},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L614321344&from=export},
doi = {10.1177/0309364616637954},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {1},
pages = {65–77},
address = {E. Pröbsting, Otto Bock HealthCare GmbH, Department Clinical Research and Services, Goettingen, Germany},
abstract = {Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.},
keywords = {adult, aged, ankle foot orthosis, article, C Brace, clinical article, daily life activity, device safety, E MAG Active, female, follow up, Free Walk, Horton SCO, human, KAFO SPL, knee-ankle-foot orthosis, male, microprocessor stance and swing control orthosis, middle aged, NEURO MATIC, patient-reported outcome, standing, very elderly, walking},
pubstate = {published},
tppubtype = {article}
}
Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.
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.
Abstract | Links | Schlagwörter: above knee amputation, adult, aged, article, biomechanics, body position, C-leg, clinical article, College Park Trustep, controlled study, female, foot prosthesis, gait, gait biomechanics, hip, hip extension moment, human, knee power, knee prosthesis, Low Profile Vari-Flex, male, musculoskeletal system parameters, priority journal, range of motion, robotic variable impedance prosthetic knee, step length symmetry, torso lean angle, Triton, VI Knee, walking speed
@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 = {above knee amputation, adult, aged, article, biomechanics, body position, C-leg, clinical article, College Park Trustep, controlled study, female, foot prosthesis, gait, gait biomechanics, hip, hip extension moment, human, knee power, knee prosthesis, Low Profile Vari-Flex, male, musculoskeletal system parameters, priority journal, range of motion, robotic variable impedance prosthetic knee, step length symmetry, torso lean angle, Triton, VI Knee, walking speed},
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.
2010
Ludwigs, E.; Bellmann, M.; Schmalz, T.; Blumentritt, S.
Biomechanical differences between two exoprosthetic hip joint systems during level walking Artikel
In: Prosthet. Orthot. Int., Bd. 34, Nr. 4, S. 449–460, 2010, ISSN: 1746-1553.
Abstract | Links | Schlagwörter: 7E7 hip joint, adult, aged, article, biomechanics, C-leg, C-walk, clinical article, devices, energy consumption, female, gait, Helix3D Hip Joint, hip prosthesis, human, kinematics, knee function, male, swing phase, walking
@article{Ludwigs2010,
title = {Biomechanical differences between two exoprosthetic hip joint systems during level walking},
author = {E. Ludwigs and M. Bellmann and T. Schmalz and S. Blumentritt},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L360015209&from=export},
doi = {10.3109/03093646.2010.499551},
issn = {1746-1553},
year = {2010},
date = {2010-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {34},
number = {4},
pages = {449–460},
address = {E. Ludwigs, Research Department, Otto Bock HealthCare GmbH, Hermann-Rein-Str. 2a, Gttingen, 37075, Germany},
abstract = {Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.},
keywords = {7E7 hip joint, adult, aged, article, biomechanics, C-leg, C-walk, clinical article, devices, energy consumption, female, gait, Helix3D Hip Joint, hip prosthesis, human, kinematics, knee function, male, swing phase, walking},
pubstate = {published},
tppubtype = {article}
}
Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.
2004
Wit, D. C. M.; Buurke, J. H.; Nijlant, J. M. M.; IJzerman, M. J.; Hermens, H. J.
In: Clin. Rehabil., Bd. 18, Nr. 5, S. 550–557, 2004, ISSN: 0269-2155.
Abstract | Links | Schlagwörter: adult, aged, article, Camp, cerebrovascular accident, chronic disease, climbing, clinical article, clinical trial, controlled clinical trial, controlled study, crossover procedure, Distrac, Dynafo, female, gait disorder, human, male, motivation, motor performance, orthosis, Ottobock, randomized controlled trial, scoring system, self esteem, standing, statistical analysis, task performance, walking speed
@article{Wit2004,
title = {The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: A randomized controlled trial},
author = {D. C. M. Wit and J. H. Buurke and J. M. M. Nijlant and M. J. IJzerman and H. J. Hermens},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L39076880&from=export},
doi = {10.1191/0269215504cr770oa},
issn = {0269-2155},
year = {2004},
date = {2004-01-01},
journal = {Clin. Rehabil.},
volume = {18},
number = {5},
pages = {550–557},
address = {D.C.M. de Wit, Roessingh Research and Development, Roessinghbleekweg 33B, 7522 AH Enschede, Netherlands},
abstract = {Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFC) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO. © Arnold 2004.},
keywords = {adult, aged, article, Camp, cerebrovascular accident, chronic disease, climbing, clinical article, clinical trial, controlled clinical trial, controlled study, crossover procedure, Distrac, Dynafo, female, gait disorder, human, male, motivation, motor performance, orthosis, Ottobock, randomized controlled trial, scoring system, self esteem, standing, statistical analysis, task performance, walking speed},
pubstate = {published},
tppubtype = {article}
}
Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFC) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO. © Arnold 2004.
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.
2017
Pröbsting, E.; Kannenberg, A.; Zacharias, B.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 1, S. 65–77, 2017, ISSN: 0309-3646.
@article{Proebsting2017,
title = {Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis},
author = {E. Pröbsting and A. Kannenberg and B. Zacharias},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L614321344&from=export},
doi = {10.1177/0309364616637954},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {1},
pages = {65–77},
address = {E. Pröbsting, Otto Bock HealthCare GmbH, Department Clinical Research and Services, Goettingen, Germany},
abstract = {Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.
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.
2010
Ludwigs, E.; Bellmann, M.; Schmalz, T.; Blumentritt, S.
Biomechanical differences between two exoprosthetic hip joint systems during level walking Artikel
In: Prosthet. Orthot. Int., Bd. 34, Nr. 4, S. 449–460, 2010, ISSN: 1746-1553.
@article{Ludwigs2010,
title = {Biomechanical differences between two exoprosthetic hip joint systems during level walking},
author = {E. Ludwigs and M. Bellmann and T. Schmalz and S. Blumentritt},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L360015209&from=export},
doi = {10.3109/03093646.2010.499551},
issn = {1746-1553},
year = {2010},
date = {2010-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {34},
number = {4},
pages = {449–460},
address = {E. Ludwigs, Research Department, Otto Bock HealthCare GmbH, Hermann-Rein-Str. 2a, Gttingen, 37075, Germany},
abstract = {Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.
2004
Wit, D. C. M.; Buurke, J. H.; Nijlant, J. M. M.; IJzerman, M. J.; Hermens, H. J.
In: Clin. Rehabil., Bd. 18, Nr. 5, S. 550–557, 2004, ISSN: 0269-2155.
@article{Wit2004,
title = {The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: A randomized controlled trial},
author = {D. C. M. Wit and J. H. Buurke and J. M. M. Nijlant and M. J. IJzerman and H. J. Hermens},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L39076880&from=export},
doi = {10.1191/0269215504cr770oa},
issn = {0269-2155},
year = {2004},
date = {2004-01-01},
journal = {Clin. Rehabil.},
volume = {18},
number = {5},
pages = {550–557},
address = {D.C.M. de Wit, Roessingh Research and Development, Roessinghbleekweg 33B, 7522 AH Enschede, Netherlands},
abstract = {Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFC) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO. © Arnold 2004.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFC) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO. © Arnold 2004.