Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations

In able-bodied individuals, the ankle joint functions to provide shock absorption, aid in foot clearance during the swing phase, and provides a rocker mechanism during stance phase to facilitate forward progression of the body. Prosthetic ankles currently used by persons with lower limb amputations provide considerably less function than their anatomical counterparts. However, increased ankle motion in the sagittal plane may improve the gait of persons with lower limb amputations while providing a more versatile prosthesis. The primary aim of this study was to examine and quantify temporal-spatial, kinematic, and kinetic changes in the gait of four male subjects with bilateral trans-femoral amputations who walked with and without prosthetic ankle units. Two prosthesis configurations were examined: (i) Baseline with only two Seattle LightFoot2 prosthetic feet, and (ii) with the addition of Endolite Multiflex Ankle units. Data from the gait analyses were compared between prosthetic configurations and with a control group of able-bodied subjects. The amputee subjects' freely-selected walking speeds, 0.74 ± 0.19 m/s for the Baseline condition and 0.81 ± 0.15 m/s with the ankle units, were much less than that of the control subjects (1.35 ± 0.10 m/s). The amputee subjects demonstrated no difference in walking speed, step length, cadence, or ankle, knee, and hip joint moments and powers between the two prosthesis configurations. Sagittal plane ankle range of motion, however, increased by 3–8° with the addition of the prosthetic ankle units. Compared to the control group, following initial contact the amputee subjects passively increased the rate of energy storage or dissipation at the prosthetic ankle joint, actively increased the power generation at the hip, and increased the extension moment at the hip while wearing the prosthetic ankle configuration. The amputee subjects increased the power generation at their hips, possibly as compensation for the reduced rate of energy return at their prosthetic ankles. Results from subject questionnaires administered following the gait analyses revealed that the prosthetic ankle units provided more comfort during gait and did not increase the perceived effort to walk. The subjects also indicated that they preferred walking with the prosthetic ankle units compared to the Baseline configuration. The results of the study showed that the prosthetic ankle units improved sagittal plane ankle range of motion and increased the comfort and functionality of the amputee subjects’ prostheses by restoring a significant portion of the ankle rocker mechanism during stance phase. Therefore, prosthetic ankle mechanisms should be considered a worthwhile option when prostheses are prescribed for persons with trans-femoral amputations.

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Video Feedback and 2-Dimensional Landing Kinematics in Elite Female Handball Players

Journal of Athletic Training ◽

10.4085/1062-6050-52.10.11 ◽

2017 ◽

Vol 52 (11) ◽

pp. 993-1001 ◽

Cited By ~ 3

Author(s):

Anne Benjaminse ◽

Wytze Postma ◽

Ina Janssen ◽

Egbert Otten

Keyword(s):

Range Of Motion ◽

Repeated Measures ◽

Sagittal Plane ◽

Cruciate Ligament ◽

Injury Rate ◽

Video Feedback ◽

Ligament Injury ◽

Control Group ◽

Initial Contact ◽

Video Group

Context: In team handball, an anterior cruciate ligament injury often occurs during landing after a jump shot. Many intervention programs try to reduce the injury rate by instructing athletes to land more safely. Video is an effective way to provide feedback, but little is known about its influence on landing technique in sport-specific situations. Objective: To test the effectiveness of a video-overlay feedback method on landing technique in elite handball players. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 16 elite female handball players assigned to a control group (n = 8; age = 17.61 ± 1.34 years, height = 1.73 ± 0.06 m, mass = 69.55 ± 4.29 kg) or video group (n = 8; age = 17.81 ± 0.86 years, height = 1.71 ± 0.03 m, mass = 64.28 ± 6.29 kg). Intervention(s): Both groups performed jump shots in a pretest, 2 training sessions, and a posttest. The video group received video feedback of an expert model with an overlay of their own jump shots in training sessions 1 and 2, whereas the control group did not. Main Outcome Measure(s): We measured ankle, knee, and hip angles in the sagittal plane at initial contact and peak flexion; range of motion; and Landing Error Scoring System (LESS) scores. One 2 × 4 repeated-measures analysis of variance was conducted to analyze the group, time, and interaction effects of all kinematic outcome measures and the LESS score. Results: The video group improved knee and hip flexion at initial contact and peak flexion and range of motion. In addition, the group's average peak ankle flexion (12.0° at pretest to 21.8° at posttest) and LESS score (8.1 pretest to 4.0 posttest) improved. When we considered performance variables, no differences between groups were found in shot accuracy or vertical jump height, whereas horizontal jump distance in the video group increased over time. Conclusions: Overlay visual feedback is an effective method for improving landing kinematics during a sport-specific jump shot. Further research is warranted to determine the long-term effects and transfer to training and game situations.

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Lower Extremity Kinematics and Ground Reaction Forces After Prophylactic Lace-Up Ankle Bracing

Journal of Athletic Training ◽

10.4085/1062-6050-43.3.234 ◽

2008 ◽

Vol 43 (3) ◽

pp. 234-241 ◽

Cited By ~ 53

Author(s):

Lindsay J. DiStefano ◽

Darin A. Padua ◽

Cathleen N. Brown ◽

Kevin M. Guskiewicz

Keyword(s):

Lower Extremity ◽

Range Of Motion ◽

Knee Flexion ◽

Sagittal Plane ◽

Control Group ◽

Ground Contact ◽

Long Term Effects ◽

Ankle Motion ◽

Reaction Forces ◽

Ankle Bracing

Abstract Context: Long-term effects of ankle bracing on lower extremity kinematics and kinetics are unknown. Ankle motion restriction may negatively affect the body's ability to attenuate ground reaction forces (GRFs). Objective: To evaluate the immediate and long-term effects of ankle bracing on lower extremity kinematics and GRFs during a jump landing. Design: Experimental mixed model (2 [group] × 2 [brace] × 2 [time]) with repeated measures. Setting: Sports medicine research laboratory. Patients or Other Participants: A total of 37 healthy subjects were assigned randomly to either the intervention (n = 11 men, 8 women; age = 19.63 ± 0.72 years, height = 176.05 ± 10.58 cm, mass = 71.50 ± 13.15 kg) or control group (n = 11 men, 7 women; age = 19.94 ± 1.44 years, height = 179.15 ± 8.81 cm, mass = 74.10 ± 10.33 kg). Intervention(s): The intervention group wore braces on both ankles and the control group did not wear braces during all recreational activities for an 8-week period. Main Outcome Measure(s): Initial ground contact angles, maximum joint angles, time to reach maximum joint angles, and joint range of motion for sagittal-plane knee and ankle motion were measured during a jump-landing task. Peak vertical GRF and the time to reach peak vertical GRF were assessed also. Results: While participants were wearing the brace, ankle plantar flexion at initial ground contact (brace = 35° ± 13°, no brace = 38° ± 15°, P = .024), maximum dorsiflexion (brace = 21° ± 7°, no brace = 22° ± 6°, P = .04), dorsiflexion range of motion (brace = 56° ± 14°, no brace = 59° ± 16°, P = .001), and knee flexion range of motion (brace = 79° ± 16°, no brace = 82° ± 16°, P = .036) decreased, whereas knee flexion at initial ground contact increased (brace = 12° ± 9°, no brace = 9° ± 9°, P = .0001). Wearing the brace for 8 weeks did not affect any of the outcome measures, and the brace caused no changes in vertical GRFs (P > .05). Conclusions: Although ankle sagittal-plane motion was restricted with the brace, knee flexion upon landing increased and peak vertical GRF did not change. The type of lace-up brace used in this study appeared to restrict ankle motion without increasing knee extension or vertical GRFs and without changing kinematics or kinetics over time.

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Lower Limb Joint Kinetics During a Side-Cutting Task in Participants With or Without Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-334-18 ◽

2020 ◽

Vol 55 (2) ◽

pp. 169-175 ◽

Cited By ~ 2

Author(s):

Jeffrey D. Simpson ◽

Ethan M. Stewart ◽

Alana J. Turner ◽

David M. Macias ◽

Harish Chander ◽

...

Keyword(s):

Hip Joint ◽

Lower Limb ◽

Stance Phase ◽

Sagittal Plane ◽

Ankle Instability ◽

Reaction Force ◽

Joint Stiffness ◽

Control Group ◽

Joint Kinetics ◽

3 Dimensional

Context Individuals with chronic ankle instability (CAI) demonstrate altered lower limb movement dynamics during jump landings, which can contribute to recurrent injury. However, the literature examining lower limb movement dynamics during a side-cutting task in individuals with CAI is limited. Objective To assess lower limb joint kinetics and sagittal-plane joint stiffness during the stance phase of a side-cutting task in individuals with or without CAI. Design Cohort study. Setting Motion-capture laboratory. Patients or Other Participants Fifteen physically active, young adults with CAI (7 men, 8 women; age = 21.3 ± 1.6 years, height = 171.0 ± 11.2 cm, mass = 73.4 ± 15.2 kg) and 15 healthy matched controls (7 men, 8 women; age = 21.5 ± 1.5 years, height = 169.9 ± 10.6 cm, mass = 75.5 ± 13.0 kg). Intervention(s) Lower limb 3-dimensional kinematic and ground reaction force data were recorded while participants completed 3 successful trials of a side-cutting task. Net internal joint moments, in addition to sagittal-plane ankle-, knee-, and hip-joint stiffness, were computed from 3-dimensional kinematic and ground reaction force data during the stance phase of the side-cutting task and analyzed. Main Outcome Measure(s) Data from each participant's stance phase were normalized to 100% from initial foot contact (0%) to toe-off (100%) to compute means, standard deviations, and Cohen d effect sizes for all dependent variables. Results The CAI group exhibited a reduced ankle-eversion moment (39%–81% of stance phase) and knee-abduction moment (52%–75% of stance phase) and a greater ankle plantar-flexion moment (3%–16% of stance phase) than the control group (P range = .009–.049). Sagittal-plane hip-joint stiffness was greater in the CAI than in the control group (t28 = 1.978, P = .03). Conclusions Our findings suggest that altered ankle-joint kinetics and increased hip-joint stiffness were associated when individuals with CAI performed a side-cutting task. These lower limb kinetic changes may contribute to an increased risk of recurrent lateral ankle sprains in people with CAI. Clinicians and practitioners can use these findings to develop rehabilitation programs for improving maladaptive movement mechanics in individuals with CAI.

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INFLUENCE OF FOOT INSOLE ON THE GAIT PERFORMANCE IN SUBJECTS WITH FLAT FOOT DISORDER

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419500507 ◽

2019 ◽

Vol 19 (06) ◽

pp. 1950050

Author(s):

M. T. KARIMI ◽

R. B. TAHMASEBI ◽

B. SATVATI ◽

F. FATOYE

Keyword(s):

Range Of Motion ◽

Ankle Joint ◽

Lower Limb ◽

Walking Speed ◽

Force Plate ◽

Flat Foot ◽

Gait Performance ◽

Positive Effects ◽

Significant Difference ◽

Foot Disorder

Flat foot is the most common foot disorder that influences the alignment of the lower limb structure. It is controversial whether the use of foot insole influences kinetic and kinematic of the leg or not. Therefore, this study investigated the influence of foot insole on the gait performance in subjects with flat foot disorder. A group of flat foot subject was recruited into this study (the number of subjects was 15). The motion of the leg joints was determined using the Qualysis motion analysis system. Moreover, the force applied on the lower limb was recorded by a Kistler force plate. The range of motion of the lower limb joints, the moments applied on the lower limb joints and force transmitted through the leg were the parameters used in this study. The difference between these parameters during walking with and without insole was evaluated using the paired [Formula: see text]-test. Significant value was set at [Formula: see text]. There was no significant difference between the range of motion of ankle joint while walking with and without insole. However, the medial directed force applied on the leg decreased significantly [Formula: see text]. The use of foot insole did not influence the moments transmitted through the hip and knee joints. The walking speed of the subjects improved while walking with foot insole. Use of foot insole influenced the magnitude of the force applied on the leg and the adductor moment of ankle joint due to its influence on foot alignment. As the walking speed of the improved subjects follows the use of insole, it can be concluded that it may have a positive effects on the performance of flat foot subjects.

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Balance Strategy Exercise versus Lower Limb-ROM Exercise for Reducing the Risk of Falls among Older People

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v11i1.33229 ◽

2021 ◽

Vol 11 (1) ◽

pp. 114-123

Author(s):

Zakia Azkia ◽

Rahmi Setiyani ◽

Lita Heni Kusumawardani

Keyword(s):

Nursing Homes ◽

Older People ◽

Range Of Motion ◽

Lower Limb ◽

Institutional Care ◽

Control Group ◽

Timed Up And Go ◽

Term Care ◽

Risk Of Falls ◽

Balance Strategy

Background: Falls are a significant health problem and the most common cause of injuries in older people. Different types of exercise have been recommended to prevent falls, including balance exercise and range of motion. However, there is a lack of evidence to compare the effect of the two exercises.Purpose: This study aimed to compare the effect of Balance Strategy Exercise (BSE) and Lower Limb-Range of Motion (ROM) exercise on reducing the risk of falls among older people living in long-term care facilities. Methods: This was a quasi-experimental study using a pre-post design without a control group. A total of 30 older adults from two nursing homes who met the inclusion and exclusion criteria participated in the study. A cluster randomization technique was used to assign the older people into either BSE or Lower-Limb ROM groups evenly. Treatment was given for 30 minutes per session, three sessions per week for three weeks. The risk of falls was measured using the Timed Up and Go (TUG) test. The paired t-test, Wilcoxon and Mann-Whitney U-test were used to analyze the data. Results: Results showed significant differences in the TUG scores before and after the intervention within both the BSE (p=0.001) and the Lower Limb-ROM group (p=0.001). However, the Lower Limb-ROM group demonstrated a significantly higher reduction in TUG score than the BSE group after the intervention (p=0.008).Conclusion: Lower Limb-ROM exercise is better to reduce the risk of falls among older people living in institutional care than BSE. This exercise can be applied as part of a fall prevention program in nursing homes.

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Effectiveness of Virtual Reality and Visual Feedback on Balance and Leg Function in Children with Cerebral Palsy

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i18.748 ◽

2019 ◽

Vol 1 (18) ◽

Author(s):

Arūnė Dūdaitė ◽

Vilma Juodžbalienė

Keyword(s):

Virtual Reality ◽

Cerebral Palsy ◽

Postural Control ◽

Range Of Motion ◽

Visual Feedback ◽

Lower Limb ◽

Dynamic Balance ◽

Control Group ◽

Children With Cerebral Palsy ◽

Stretching Exercises

Research background. Virtual reality and visual feedback improve motor performance, motor function and balance, so we want to fnd if it aﬀects the function of legs and balance of children with spastic hemiplegia. Research aim was to establish if the use of virtual reality and visual feedback with traditional physiotherapy improve the function of legs and balance of children with cerebral palsy. Methods. Nine children with cerebral palsy participated in the research. Participants were randomly divided into two groups – virtual reality group (n = 6) and control (n = 3). Virtual reality group practised exergaming and stretching exercises for 10 weeks, twice a week. Control group practiced conventional physiotherapy and stretching exercises for 6 weeks, twice a week. We measured the range of motion of the lower limb, spasticity of the lower limb using Modifed Ashworth’o Scale, static, dynamic balance, trunk coordination using Trunk Impairment Scale at the start and the end of the research, and balance using Pediatric Balance Scale. Results. Virtual reality and visual feedback reduced the spasticity of the lower limb, improved balance and postural control for children with cerebral palsy, but it did not improve the range of motion of the lower limb of children with cerebral palsy. Conclusions. Virtual reality and visual feedback did not improve the range of motion of the lower limb of children with cerebral palsy. Virtual reality and visual feedback reduced spasticity of the lower limb, improved balance and postural control for children with cerebral palsy.Keywords. Cerebral palsy, virtual reality, visual feedback, postural control, muscle architecture.

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Improvements in Pain, Well-being, Arterial Pressure, and Lower Limb Volume Following Andullation Therapy in Healthy and Unhealthy Humans

Dose-Response ◽

10.1177/1559325819840838 ◽

2019 ◽

Vol 17 (2) ◽

pp. 155932581984083

Author(s):

Alba Parras-Moltó ◽

Juan Ribas-Serna

Keyword(s):

Arterial Pressure ◽

Lower Limb ◽

Pain Threshold ◽

Pain Perception ◽

Well Being ◽

The Body ◽

Control Group ◽

Subjective Perception ◽

Limb Volume ◽

Random Fashion

Our aim was to test the effects of Andullation therapy on pain threshold, pain perception, feeling of well-being, arterial pressure, and leg volume in healthy and unhealthy patients. We used a multidirectional vibration (frequency range: 5–40 Hz; peak-to-peak amplitude: 2–8 mm; acceleration: 0.4–2 m/s2) in an undulatory way through the surface of the body when the patient was in contact with a mattress (“andullation”). The vibes traveled from the heel to the head in a random fashion while the participants (N = 50) were lying on the mattress. We measured the pain threshold using an algometer; pain perception and well-being through a visual analog scale (VAS); arterial pressure with an electronic sphygmomanometer; and leg volume with Kuhnke’s technique. Measurements were made just before the first andullation session and after the fifth andullation session. Every participant received andullation sessions of 30 min a day for 5 consecutive days. The patients’ pain threshold significantly ( P < .001) increased by 34.48% and 25.79% in the lumbar and trapezius zones, respectively, after 5 sessions of therapy. The subjective perception of pain decreased by 52.3% and the feeling of well-being increased by 45.1%. The systolic and diastolic pressures significantly ( P < .001) decreased by 6.44 and 4.68 mm Hg on average, respectively. Leg volume significantly decreased ( P < .01) by 64.39 mL after the fifth andullation session. Despite not including a control group in our study, the andullation intervention showed an improvement in pain, well-being, arterial pressure, and lower limb volume in the studied population.

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Changes in Ankle Range of Motion, Gait Function and Standing Balance in Children with Bilateral Spastic Cerebral Palsy after Ankle Mobilization by Manual Therapy

Children ◽

10.3390/children7090142 ◽

2020 ◽

Vol 7 (9) ◽

pp. 142

Author(s):

Pong Sub Youn ◽

Kyun Hee Cho ◽

Shin Jun Park

Keyword(s):

Cerebral Palsy ◽

Range Of Motion ◽

Ankle Joint ◽

Center Of Pressure ◽

Standing Balance ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Walk Test ◽

Joint Mobilization ◽

Gait Function

The aim of this study was to investigate the effect of ankle joint mobilization in children with cerebral palsy (CP) to ankle range of motion (ROM), gait, and standing balance. We recruited 32 children (spastic diplegia) diagnosed with CP and categorized them in two groups: the ankle joint mobilization (n = 16) group and sham joint mobilization (n = 16) group. Thus, following a six-week ankle joint mobilization, we examined measures such as passive ROM in ankle dorsiflexion in the sitting and supine position, center of pressure (COP) displacements (sway length, area) with eyes open (EO) and closed (EC), and a gait function test (timed up and go test (TUG) and 10-m walk test). The dorsiflexion ROM, TUG, and 10-m walk test significantly increased in the mobilization group compared to the control group. Ankle joint mobilization can be regarded as a promising method to increase dorsiflexion and improve gait in CP-suffering children.

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Accelerometer-Based Navigation in Total Knee Arthroplasty for the Management of Extra-Articular Deformity and Retained Femoral Hardware: Analysis of Component Alignment

Joints ◽

10.1055/s-0039-1697610 ◽

2019 ◽

Vol 07 (01) ◽

pp. 001-007 ◽

Cited By ~ 1

Author(s):

Andrea Cozzi Lepri ◽

Matteo Innocenti ◽

Fabrizio Matassi ◽

Marco Villano ◽

Roberto Civinini ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Navigation System ◽

Lower Limb ◽

Sagittal Plane ◽

Frontal Plane ◽

Control Group ◽

Navigation Systems ◽

Level Of Evidence ◽

Total Knee

Abstract Purpose Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89–91) and on the sagittal plane 5.0° (range 3–7). The alignment of the femoral component on the frontal plane was 90.0° (range 89–91) and on the sagittal plane 3.0° (range 0–5). Conclusion The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence This is an observational study without a control group, Level III.

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Interpretation of Ankle Joint Moments during the Stance Phase of Walking: A Comparison of Two Orthogonal Axes Systems

Journal of Applied Biomechanics ◽

10.1123/jab.17.2.173 ◽

2001 ◽

Vol 17 (2) ◽

pp. 173-180 ◽

Cited By ~ 5

Author(s):

Adrienne E. Hunt ◽

Richard M. Smith

Keyword(s):

Coordinate System ◽

Ankle Joint ◽

Stance Phase ◽

Reaction Force ◽

Frontal Plane ◽

Transverse Plane ◽

The Body ◽

Global Coordinate System ◽

Coordinate Systems ◽

Joint Moments

Three-dimensional ankle joint moments were calculated in two separate coordinate systems, from 18 healthy men during the stance phase of walking, and were then compared. The objective was to determine the extent of differences in the calculated moments between these two commonly used systems and their impact on interpretation. Video motion data were obtained using skin surface markers, and ground reaction force data were recorded from a force platform. Moments acting on the foot were calculated about three orthogonal axes, in a global coordinate system (GCS) and also in a segmental coordinate system (SCS). No differences were found for the sagittal moments. However, compared to the SCS, the GCS significantly (p < .001) overestimated the predominant invertor moment at midstance and until after heel rise. It also significantly (p < .05) underestimated the late stance evertor moment. This frontal plane discrepancy was attributed to sensitivity of the GCS to the degree of abduction of the foot. For the transverse plane, the abductor moment peaked earlier (p < .01) and was relatively smaller (p < .01) in the GCS. Variability in the transverse plane was greater for the SCS, and attributed to its sensitivity to the degree of rearfoot inversion. We conclude that the two coordinate systems result in different calculations of nonsagittal moments at the ankle joint during walking. We propose that the body-based SCS provides a more meaningful interpretation of function than the GCS and would be the preferred method in clinical research, for example where there is marked abduction of the foot.

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