scholarly journals Effects of extended stance time on a powered knee prosthesis and gait symmetry on the lateral control of balance during walking in individuals with unilateral amputation

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Andrea Brandt ◽  
He ( Helen) Huang
Keyword(s):  
Visual Feedback ◽  
Lower Limb ◽  
Knee Prosthesis ◽  
Center Of Mass ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Gait Symmetry ◽  
Margin Of Stability ◽  
Hip Abductor ◽  
Stance Time

Abstract Background Individuals with lower limb amputation commonly exhibit large gait asymmetries that are associated with secondary health issues. It has been shown that they are capable of attaining improved temporal and propulsive symmetry when walking with a powered knee prosthesis and visual feedback, but they perceive this pattern of gait to be more difficult. Rather than improving the efficiency of gait, improved gait symmetry may be increasing individuals’ effort associated with maintaining lateral balance. Methods In this study, we used a simple visual feedback paradigm to increase the prosthesis-side stance time of six individuals with unilateral TFA or KD as they walked on a powered knee prosthesis at their self-selected speed. As they walked more symmetrically, we evaluated changes in medial-lateral center-of-mass excursion, lateral margin of stability, stride width, and hip abductor activity. Results As the subjects increased their prosthesis-side stance time, their center-of-mass excursion and hip abductor activity significantly increased, while their lateral margin of stability significantly decreased on the prosthesis-side only. Stride width remained relatively unchanged with testing condition. Conclusions Extended stance time on a powered knee prosthesis (yielding more symmetric gait) challenged the lateral balance of individuals with lower limb amputation. Lateral stability may be a reason they prefer an asymmetric gait, even with more advanced technology. Hip muscular changes post-amputation may contribute to the decline in stability on the prosthesis side. Interventions and advancements in prosthesis control aimed at improving their control of lateral balance may ameliorate the difficulty in walking with improved gait symmetry.

scholarly journals Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Andrea Brandt ◽  
William Riddick ◽  
Jonathan Stallrich ◽  
Michael Lewek ◽  
He Helen Huang
Keyword(s):  
Visual Feedback ◽  
Repeated Measures ◽  
Knee Prosthesis ◽  
Motor Pattern ◽  
Side Peak ◽  
Time Asymmetry ◽  
Gait Symmetry ◽  
Time Symmetry ◽  
Stance Time ◽  
Powered Prosthesis

Abstract Background Establishing gait symmetry is a major aim of amputee rehabilitation and may be more attainable with powered prostheses. Though, based on previous work, we postulate that users transfer a previously-learned motor pattern across devices, limiting the functionality of more advanced prostheses. The objective of this study was to preliminarily investigate the effect of increased stance time via visual feedback on amputees’ gait symmetry using powered and passive knee prostheses. Methods Five individuals with transfemoral amputation or knee disarticulation walked at their self-selected speed on a treadmill. Visual feedback was used to promote an increase in the amputated-limb stance time. Individuals were fit with a commercially-available powered prosthesis by a certified prosthetist and practiced walking during a prior visit. The same protocol was completed with a passive knee and powered knee prosthesis on separate days. We used repeated-measures, two-way ANOVA (alpha = 0.05) to test for significant effects of the feedback and device factors. Our main outcome measures were stance time asymmetry, peak anterior-posterior ground reaction forces, and peak anterior propulsion asymmetry. Results Increasing the amputated-limb stance time via visual feedback significantly improved the stance time symmetry (p = 0.012) and peak propulsion symmetry (p = 0.036) of individuals walking with both prostheses. With the powered knee prosthesis, the highest feedback target elicited 36% improvement in stance time symmetry, 22% increase in prosthesis-side peak propulsion, and 47% improvement in peak propulsion symmetry compared to a no feedback condition. The changes with feedback were not different with the passive prosthesis, and the main effects of device/ prosthesis type were not statistically different. However, subject by device interactions were significant, indicating individuals did not respond consistently with each device (e.g. prosthesis-side propulsion remained comparable to or was greater with the powered versus passive prosthesis for different subjects). Overall, prosthesis-side peak propulsion averaged across conditions was 31% greater with the powered prosthesis and peak propulsion asymmetry improved by 48% with the powered prosthesis. Conclusions Increasing prosthesis-side stance time via visual feedback favorably improved individuals’ temporal and propulsive symmetry. The powered prosthesis commonly enabled greater propulsion, but individuals adapted to each device with varying behavior, requiring further investigation.

scholarly journals A Coronally Clutching Ankle to Improve Amputee Balance on Coronally Uneven and Unpredictable Terrain

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Kyle H. Yeates ◽  
Ava D. Segal ◽  
Richard R. Neptune ◽  
Glenn K. Klute
Keyword(s):  
Lower Limb ◽  
Dynamic Balance ◽  
Center Of Mass ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Initial Contact ◽  
Plane Angle ◽  
Prosthetic Foot ◽  
Uneven Terrain ◽  
Recovery Strategies

To improve the balance of individuals with lower limb amputation on coronally uneven terrain, a coronally clutching ankle (CCA) was developed to actively adapt through ±15 deg of free coronal foot rotation during the first ∼60 ms of initial contact. Three individuals with lower limb amputations were fit with the CCA and walked across an instrumented walkway with a middle step that was either flush, 15 deg inverted, or 15 deg everted. An opaque latex membrane was placed over the middle step, making the coronally uneven terrain unpredictable. Compared to participants' clinically prescribed prosthesis, the CCA exhibited significantly more coronal angular adaption during early stance. The CCA also improved participants' center of mass (COM) path regulation during the recovery step (reduced variation in mediolateral position) and reduced the use of the hip and stepping recovery strategies, suggesting it improved participants' balance and enabled a quicker recovery from the disturbance. However, use of the CCA did not significantly affect participants' ability to regulate their coronal angular momentum during the disturbance, suggesting that the CCA did not improve all elements of dynamic balance. Reducing the distance between the CCA's pivot axis and the base of the prosthetic foot might resolve this issue. These findings suggest that actively adapting the coronal plane angle of a prosthetic ankle can improve certain elements of balance for individuals with lower limb amputation who walk on coronally uneven and unpredictable terrain.

Inertial sensor-based measures of gait symmetry and repeatability in people with unilateral lower limb amputation

2020 ◽  
Vol 72 ◽  
pp. 102-107 ◽  
Author(s):  
Sheila Clemens ◽  
Kyoung Jae Kim ◽  
Robert Gailey ◽  
Neva Kirk-Sanchez ◽  
Anat Kristal ◽  
...  
Keyword(s):  
Lower Limb ◽  
Inertial Sensor ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Gait Symmetry

scholarly journals P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
B Gwilym ◽  
C Waldron ◽  
E Thomas-Jones ◽  
P Pallmann ◽  
R Preece ◽  
...  
Keyword(s):  
Risk Prediction ◽  
Lower Limb ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Demographic Data ◽  
Collaborative Study ◽  
Lower Limb Amputation ◽  
Research Network ◽  
Limb Amputation ◽  
Prediction Tools

Abstract Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.

scholarly journals Socio-economic outcome of paraplegia compared to lower limb amputation

Spinal Cord ◽  
2002 ◽  
Vol 40 (4) ◽  
pp. 174-177 ◽  
Author(s):  
A Cavigelli ◽  
R Fischer ◽  
V Dietz
Keyword(s):  
Lower Limb ◽  
Lower Limb Amputation ◽  
Economic Outcome ◽  
Limb Amputation
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