scholarly journals Mechanisms to Attenuate Load in the Intact Limb of Transtibial Amputees When Performing a Unilateral Drop Landing

2020 ◽  
Vol 36 (1) ◽  
pp. 4-12
Author(s):  
Sarah C. Moudy ◽  
Neale A. Tillin ◽  
Amy R. Sibley ◽  
Siobhán Strike
Keyword(s):  
Quadriceps Strength ◽  
Joint Mechanics ◽  
Work Demand ◽  
Prosthetic Limb ◽  
Drop Landing ◽  
Limb Loading ◽  
Healthy Control ◽  
Movement Mechanics ◽  
Transtibial Amputees ◽  
Intact Limb

Individuals with unilateral transtibial amputations experience greater work demand and loading on the intact limb compared with the prosthetic limb, placing this limb at a greater risk of knee joint degenerative conditions. It is possible that increased loading on the intact side may occur due to strength deficits and joint absorption mechanics. This study investigated the intact limb mechanics utilized to attenuate load, independent of prosthetic limb contributions and requirements for forward progression, which could provide an indication of deficiencies in the intact limb. Amputee and healthy control participants completed 3 unilateral drop landings from a 30-cm drop height. Joint angles at touchdown; range of motion; coupling angles; peak powers; and negative work of the ankle, knee, and hip were extracted together with isometric quadriceps strength measures. No significant differences were found in the load or movement mechanics (P ≥ .31, g ≤ 0.42), despite deficits in isometric maximum (20%) and explosive (25%) strength (P ≤ .13, g ≥ 0.61) in the intact limb. These results demonstrate that, when the influence from the prosthetic limb and task demand are absent, and despite deficits in strength, the intact limb adopts joint mechanics similar to able-bodied controls to attenuate limb loading.

scholarly journals Joint internal moments in subjects with unilateral transtibial amputation during walking

2021 ◽  
Vol 2 (1) ◽  
pp. 1-6
Author(s):  
Francisco Molina-Rueda ◽  
Alicia Cuesta-Gómez ◽  
María Carratalá-Tejada ◽  
Pilar Fernández-González ◽  
Juan Carlos Miangolarra-Page ◽  
...  
Keyword(s):  
Knee Extensor ◽  
Occurrence Rate ◽  
Control Group ◽  
Transtibial Amputation ◽  
Prosthetic Limb ◽  
Motion System ◽  
The People ◽  
Hip Abductor ◽  
Kinetic Pattern ◽  
Intact Limb

Background: Subjects with a unilateral transtibial amputation (UTA) that have used prosthesis for over five years have a higher occurrence rate of osteoarthritis at the knee and hip joints of the intact limb. Objective: To research the joint internal moments of the hip, knee, and ankle in the sagittal and frontal planes during gait in persons with UTA. Methods: 25 individuals with UTA (50.26 years ± 13.76) and 25 subjects without amputation (46.71 years ± 13.76) participated in this study. Gait analysis was carried out using a Vicon® Motion System (Oxford Metrics, Oxford, UK) with eight 100 Hz cameras with infrared strobes, two 1000 Hz AMTI® force-plates. Results: People with UTA walk with a greater hip extensor moment in both intact and prosthetic limbs. The hip abductor moment was lower on the prosthetic limb compared to the intact limb and the control group. At the knee joint, the subjects with UTA walked with a reduced knee extensor and valgus moment on their prosthetic limb compared to the control group. At the ankle joint, the statistical analysis showed that the individuals with UTA walked with a reduced plantarflexor moment during the stance period on the intact limb compared to the people without amputation. Conclusions: Subjects with UTA walk with a different joint kinetic pattern in the sagittal and frontal planes compared to non-disabled individuals.

Effect of take-off from prosthetic versus intact limb on transtibial amputee long jump technique

2012 ◽  
Vol 36 (3) ◽  
pp. 297-305 ◽  
Author(s):  
L Nolan ◽  
Benjamin L Patritti ◽  
Kathy J Simpson
Keyword(s):  
Vertical Velocity ◽  
Sagittal Plane ◽  
Similar Amount ◽  
Prosthetic Limb ◽  
Approach Speed ◽  
Jump Distance ◽  
Long Jump ◽  
Correct Technique ◽  
Nonparametric Comparison ◽  
Intact Limb

Background: Increasing numbers of long jumpers with lower limb amputations choose to take off from their prosthetic limb. It is not yet known what difference in technique, if any, this requires, or which is more advantageous. Objectives: To investigate kinematic differences in long jump technique in athletes with a unilateral transtibial ampution (TT) who take off from their prosthetic limb versus those who take off from their intact limb. Study Design: Naturalistic, field-based, observational; independent group, nonparametric comparison. Methods: Two-dimensional sagittal plane kinematic analysis was performed on all athletes competing in the men’s Paralympic TT long jump finals. Five athletes took off from their prosthetic limb (TOprosth) and five from their intact limb (TOintact). Results: No differences were seen between the two groups in terms of jump distance, approach speed or vertical velocity at touch down. While in contact with the take-off board, the two groups gained a similar amount of vertical velocity. However, the TOprosth group appeared to conserve horizontal velocity by using the prosthesis as a ‘springboard’, minimizing the large hip and knee range of motion displayed by the TOintact group and athletes in previous studies. Conclusions: While differences in technique were observed, no difference was found for jump distance. Clinical relevance Athletes choosing to take-off from their prosthetic limb in long jump require a different technique to those who choose to take-off from their intact limb. Knowledge of the correct technique can help reduce excessive training which can lead to injury, particularly in the residual limb.

scholarly journals Muscle Strength and Bone Mineral Density in Mine Victims with Transtibial Amputation

2009 ◽  
Vol 33 (4) ◽  
pp. 299-306 ◽  
Author(s):  
Ilknur Tugcu ◽  
Ismail Safaz ◽  
Bilge Yilmaz ◽  
Ahmet Salim Göktepe ◽  
Mehmet Ali Taskaynatan ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Muscle Strength ◽  
Bone Mineral ◽  
Quadriceps Strength ◽  
Mineral Density ◽  
Male Veterans ◽  
Local Bone ◽  
Decisive Importance ◽  
Density Values ◽  
Transtibial Amputees

The aims of this study were to: (i) Determine if there were significant bone mineral density and muscle strength differences between intact and amputated limbs, and (ii) investigate the possible relationship between local bone loss and muscle strength in transtibial amputees. Fifteen male veterans with traumatic unilateral transtibial amputations who ranged in age from 18–45 years were included in this prospective study. Lower limb muscle strength was measured with an isokinetic dynamometer. Dual energy X-ray absorptiometry was used to determine bone mineral density of the femur and tibia. The bone mineral density values of the femur and tibia were found significantly decreased on the amputated side. Significant decreases ( p < 0.001) in strength of the quadriceps and hamstrings were observed in the amputated limb. There was a weak correlation between quadriceps strength and total femur bone mineral density ( p = 0.048, r = 0.518) on the amputated limb. Transtibial amputees are prone to bone mineral loss and muscle strength decrease on the amputated side. Our results also indicate that muscle strength itself might not be of decisive importance for bone mass in transtibial amputees.

scholarly journals Analysis of the Relative Motion Between the Socket and Residual Limb in Transtibial Amputees While Wearing a Transverse Rotation Adapter

2020 ◽  
pp. 1-9
Author(s):  
Corey A. Pew ◽  
Sarah A. Roelker ◽  
Glenn K. Klute ◽  
Richard R. Neptune
Keyword(s):  
Inverse Kinematic ◽  
External Loading ◽  
Shear Stresses ◽  
Transverse Displacement ◽  
Residual Limb ◽  
Limb Loading ◽  
Lower Limb Prosthesis ◽  
Kinematic Analyses ◽  
Transverse Rotation ◽  
Transtibial Amputees

The coupling between the residual limb and the lower-limb prosthesis is not rigid. As a result, external loading produces movement between the prosthesis and residual limb that can lead to undesirable soft-tissue shear stresses. As these stresses are difficult to measure, limb loading is commonly used as a surrogate. However, the relationship between limb loading and the displacements responsible for those stresses remains unknown. To better understand the limb motion within the socket, an inverse kinematic analysis was performed to estimate the motion between the socket and tibia for 10 individuals with a transtibial amputation performing walking and turning activities at 3 different speeds. The authors estimated the rotational stiffness of the limb-socket body to quantify the limb properties when coupled with the socket and highlight how this approach could help inform prosthetic prescriptions. Results showed that peak transverse displacement had a significant, linear relationship with peak transverse loading. Stiffness of the limb-socket body varied significantly between individuals, activities (walking and turning), and speeds. These results suggest that transverse limb loading can serve as a surrogate for residual-limb shear stress and that the setup of a prosthesis could be individually tailored using standard motion capture and inverse kinematic analyses.

Influence of External Ankle Support on Lower Extremity Joint Mechanics During Drop Landings

2010 ◽  
Vol 19 (2) ◽  
pp. 136-148 ◽  
Author(s):  
Mitchell L. Cordova ◽  
Yosuke Takahashi ◽  
Gregory M. Kress ◽  
Jody B. Brucker ◽  
Alfred E. Finch
Keyword(s):  
Knee Joint ◽  
Lower Extremity ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Angular Displacement ◽  
Joint Mechanics ◽  
Drop Landing ◽  
Joint Displacement ◽  
Ankle Support ◽  
Drop Landings

Objective:To investigate the effects of external ankle support (EAS) on lower extremity joint mechanics and vertical ground-reaction forces (VGRF) during drop landings.Design:A 1 × 3 repeated-measures, crossover design.Setting:Biomechanics research laboratory.Patients:13 male recreationally active basketball players (age 22.3 ± 2.2 y, height 177.5 ± 7.5 cm, mass 72.2 ± 11.4 kg) free from lower extremity pathology for the 12 mo before the study.Interventions:Subjects performed a 1-legged drop landing from a standardized height under 3 different ankle-support conditions.Main Outcome Measures:Hip, knee, and ankle angular displacement along with specific temporal (TGRFz1, TGRFz2; s) and spatial (GRFz1, GRFz2; body-weight units [BW]) characteristics of the VGRF vector were measured during a drop landing.Results:The tape condition (1.08 ± 0.09 BW) demonstrated less GRFz1 than the control (1.28 ± 0.16 BW) and semirigid conditions (1.28 ± 0.21 BW; P < .0001), and GRFz2 was unaffected. For TGRFz1, no-support displayed slower time (0.017 ± 0.004 s) than the semirigid (0.014 ± 0.001 s) and tape conditions (0.014 ± 0.002 s; P < .05). For TGRFz2, no-support displayed slower time (0.054 ±.006 s) than the semirigid (0.050 ± 0.006 s) and tape conditions (0.045 ± 0.004 s; P < .05). Semirigid bracing was slower than the tape condition, as well (P < .05). Ankle-joint displacement was less in the tape (34.6° ± 7.7°) and semirigid (36.8° ± 9.3°) conditions than in no-support (45.7° ± 7.3°; P < .05). Knee-joint displacement was larger in the no-support (45.1° ± 9.0°) than in the semirigid (42.6° ± 6.8°; P < .05) condition. Tape support (43.8° ± 8.7°) did not differ from the semirigid condition (P > .05). Hip angular displacement was not affected by EAS (F2,24 = 1.47, P = .25).Conclusions:EAS reduces ankle- and knee-joint displacement, which appear to influence the spatial and temporal characteristics of GRFz1 during drop landings.

scholarly journals Does Intact Limb Loading Differ in Servicemembers With Traumatic Lower Limb Loss?

2014 ◽  
Vol 472 (10) ◽  
pp. 3068-3075 ◽  
Author(s):  
Alison L. Pruziner ◽  
Kathryn M. Werner ◽  
Timothy J. Copple ◽  
Brad D. Hendershot ◽  
Erik J. Wolf
Keyword(s):  
Lower Limb ◽  
Limb Loss ◽  
Limb Loading ◽  
Intact Limb

scholarly journals Lower Limb Strength in Sports-Active Transtibial Amputees

2009 ◽  
Vol 33 (3) ◽  
pp. 230-241 ◽  
Author(s):  
Lee Nolan
Keyword(s):  
Residual Limb ◽  
Hip Strength ◽  
Prosthetic Limb ◽  
Lower Limb Strength ◽  
Flexion Extension ◽  
Strength Asymmetry ◽  
Lower Ratio ◽  
Hip Flexion ◽  
Transtibial Amputees ◽  
Flexion And Extension

The aim of this study was to compare hip strength in sports-active transtibial (TT) amputees, sedentary TT amputees and sports-active non-amputees. Three ‘active’ (exercising recreationally at least three times per week) TT amputees, four ‘inactive’ or sedentary TT amputees and nine ‘active’ able-bodied persons (AB) underwent concentric and eccentric hip flexion and extension strength testing on both limbs on an isokinetic dynamometer at 60 and 120°/s. Little strength asymmetry was noted between the limbs of the active TT amputees (8% and 14% at 60 and 120°/s, respectively), their residual limb being slightly stronger. Inactive TT amputees demonstrated up to 49% strength asymmetry, their intact limb being the stronger. Active TT amputees demonstrated greater peak hip torques (Nm/kg) for all conditions and speeds compared to inactive TT amputees. Peak hip torques (Nm/kg), were greater in the active TT amputees' residual limb compared to AB. While inactive TT amputees and AB had similar flexion/extension ratios, active TT amputees exhibited a lower ratio indicating overdeveloped hip extensors with respect to their hip flexors. It is not known whether this is due to the demands of sport or exercise with a prosthetic limb, or remaining residual thigh atrophy.

scholarly journals Metamaterial Design for Targeted Limb-Socket Interface Pressure Offloading in Transtibial Amputees

2020 ◽  
Author(s):  
Nathan Brown ◽  
Meredith K. Owen ◽  
John D. DesJardins ◽  
Anthony Garland ◽  
Georges M. Fadel
Keyword(s):  
Pressure Gradient ◽  
Mechanical Response ◽  
Pressure Gradients ◽  
Prosthetic Socket ◽  
Limb Loading ◽  
Large Pressure ◽  
Unit Cells ◽  
3D Printed ◽  
Transtibial Amputees ◽  
Socket Interface

Abstract While using a prosthesis, transtibial amputees can experience pain and discomfort brought on by large pressure gradients, at the interface between the residual limb and prosthetic socket. Current prosthetic interface solutions attempt to alleviate these pressure gradients by using soft homogenous liners to reduce and distribute pressures. This research investigates an additively manufactured metamaterial inlay with adjustable mechanical response in order to reduce peak pressure gradients around the limb. The inlay uses a hyperelastic behaving metamaterial (US10244818) comprised of triangular pattern unit cells which can be 3D printed with walls of various thicknesses controlled by draft angles. The hyperelastic material properties are modeled using a third order representation based on Yeoh 3rd order coefficients. The 3rd order coefficients can be adjusted and optimized to represent a change in the unit cell wall thickness to create an inlay that can meet the unique offloading needs of an amputee. Finite element analyses evaluated the pressure gradient reduction from: 1) A common homogenous silicone liner, 2) A prosthetist’s inlay prescription that utilizes three variations of the metamaterial, and 3) A metamaterial solution with optimized Yeoh 3rd order coefficients. When compared to a traditional homogenous silicone liner for two unique limb loading scenarios, the prosthetist prescribed inlay and optimized material inlay can achieve equal or greater pressure gradient reduction capabilities. These results show the potential feasibility of implementing this metamaterial as a method of personalized medicine for transtibial amputees by creating customizable interface solution to the meet unique performance needs of an individual patient.

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