Local dynamic stability of amputees wearing a torsion adapter compared to a rigid adapter during straight-line and turning gait

Segal, Ava D.; Orendurff, Michael S.; Czerniecki, Joseph M.; Shofer, Jane B.; Klute, Glenn K.

doi:10.1016/j.jbiomech.2010.05.038

Cited by 23 publications

(29 citation statements)

References 29 publications

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“…However, five intervention trials cover two subtopics within the pylon topic: (1) telescoping and/or teletorsion pylons and (2) monolimb prostheses with integrated elliptical versus circular shaped pylons ( Table 6). Of these, four studies scored 7/10 methodologic quality [45][46][48][49] and one scored 6/10 [47]. Regarding bias risk, all of these studies scored moderate bias risk except one [45], which scored a low bias risk.…”

Section: Pylonmentioning

confidence: 98%

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Highsmith¹,

Kahle

Miro

et al. 2016

J Rehabil Res Dev

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Abstract-Considering transtibial amputation (TTA) rehabilitation costs and complexity, high-quality literature should inform clinical practice. Systematic reviews (SRs) suggest this is not the case. This article's purpose was to review the highest-quality evidence available to guide clinical practice for TTA regarding five prosthetic intervention areas. Six databases were searched for high-quality SRs and prospective clinical trials (randomized clinical trials [RCTs]). Reviewers screened, sorted, rated (i.e., methodologic quality, bias risk), and extracted article data. Meta-analyses were conducted when possible. Thirty-one references were included (25 RCTs and 6 SRs). Five topical areas emerged (alignment, feet and ankles, interface, postoperative care, pylons). Twenty-three evidence statements were supported by level 2 evidence and eight by level 1 evidence. All RCTs reported randomization and reasonable data presentation. Concealed allocation and blinding were not widely used. Mean attrition was 11%. SRs included no meta-analyses. Functional level was poorly reported. Grouping feet and ankle components by functional classification enabled meta-analyses, though variance was considerable given the small sample sizes. Prosthetic interventions are generally safe for TTAs. High-quality literature enabled formulation of evidence statements to support select clinical practice areas, though quantity was lacking. Thus, numerous topics related to TTA care lack rigorous evidence. Although blinding in prosthetic research requires increased funding and effort, it could greatly improve the methodologic quality of prosthetic research.Abbreviations: CI = confidence interval, ESAR = energy storing and release, EWA = early walking aid, FK = flexible keel, GRF = ground reaction force, MA = multi-axial, NIH = National Institutes of Health, PEDro = Physiotherapy Evidence Database Scale, PTB = patella tendon bearing, RRD = rigid removable dressing, SA = single axis, SACH = solid ankle cushion heel, SIGN = Scottish Intercollegiate Guidelines Network, SR = systematic review, TSB = total surface bearing, TTA = transtibial amputation, VASS = vacuum-assisted suspension system, vGRF = vertical ground reaction force, VSP = vertical shock pylon.

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Section: Pylonmentioning

confidence: 98%

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Highsmith¹,

Kahle

Miro

et al. 2016

J Rehabil Res Dev

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“…However, the LyE may not detect certain changes within a prosthesis that can be characterized by more typical biomechanical measures. For example, in one of the only two other studies to examine the LyE in individuals with an amputation while walking, Segal et al reported no significant differences in LyE for individuals walking with and without a torsion adapter [47]. Their participants walked continuously in a circle.…”

Section: Lyapunov Exponent: Another Tool In Limb-loss Rehabilitationmentioning

confidence: 99%

“…The three-dimensional reconstructed attractor for Participant A also spans a larger volume than Participant B; however, the divergence in these attractors is actually very similar at LyE values of 2.27 bits/s and 2.24 bits/s. In Segal et al, it is very likely that the torsion adapter altered the magnitude of motion, but did not necessarily affect the movement pattern within the stride-to-stride fluctuations [47]. The fact that the LyE is not sensitive to movement magnitude may further increase its importance as a prescriptive or outcome measure as it is not sensitive to the magnitude differences expected between different sized individuals, allowing for comparison across heterogeneous populations of individuals with an amputation.…”

Section: Lyapunov Exponent: Another Tool In Limb-loss Rehabilitationmentioning

confidence: 99%

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Prosthesis preference is related to stride-to-stride fluctuations at the prosthetic ankle

Wurdeman

Myers

Jacobsen³

et al. 2013

JRRD

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Abstract-The purpose of this study was to determine the relationship between stride-to-stride fluctuations and prosthesis preference. Thirteen individuals with unilateral, transtibial amputation consented to participate. Individuals walked on a treadmill for 3 min with their prescribed and an alternate prosthesis. Stride-to-stride fluctuations were quantified with the largest Lyapunov exponent (LyE) of each joint flexion/extension time series. The change in the LyE was calculated for each major lower-limb joint for both conditions. Participants indicated preference between the prostheses on a continuous visual analog scale. The change in the LyE was correlated with the degree of preference between the two prostheses at the prosthetic ankle. The change in the LyE of the prosthetic ankle was strongly related to the degree of preference (r = 0.629, p = 0.02). Thus, stride-to-stride fluctuations, quantified by the LyE, are strongly related to the patient's perception of the prosthesis. As a result, the LyE is the first objective measure to detect changes in gait that relate to the patient's perception of the prosthesis. The LyE should be further examined as a potentially effective prescriptive and outcome measure in prosthetic rehabilitation.

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“…Furthermore, apart from in vivo studies that compare differences in gait with and without the presence of rotational pylon compliance through the addition of a transverse rotation adaptor [12,[52][53][54], we are not aware of any studies of the effects on gait performance of changing the properties of these adaptors (AIPPs). One case study was identified in which rotational stiffness (assumed to be those values provided by the manufacturer for the internal torsion component or "rod") was modulated in order to observe the effects on the specific kinematics of a golf swing (e.g., hip and shoulder rotation) of two transtibial amputees [37].…”

Section: Combined In Vivo and Aipp Characterization Studies That Havementioning

confidence: 99%

Stance phase mechanical characterization of transtibial prostheses distal to the socket: A review

Major¹,

Kenney²,

Twiste³

et al. 2012

JRRD

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Abstract-Achieving the required functionality of a transtibial prosthesis during the stance phase of gait (e.g., shock absorption, close to normal roll-over characteristics, and smooth transition into swing) depends on the Amputee Independent Prosthesis Properties (AIPPs), defined here as the mechanical properties of the prosthesis that directly influence the performance of the amputee. Accordingly, if research studies are to advance the design of prostheses to achieve improved user performance, AIPPs must be a primary consideration. However, the majority of reported studies can be categorized as either human performance testing of commercial prosthetic components or AIPP characterization; only in a few notable cases have studies combined these two approaches. Moreover, very little consistency exists in the current methods used for AIPP characterization, thus making comparisons between the results of such studies very difficult. This article introduces a framework for studying prosthesis design, which includes AIPP characterization, human performance and/or gait simulation studies, and detailed design. This framework provides a structure for reviewing previous approaches to AIPP characterization, discussing both their merits and shortcomings and their use in previous experimental and simulation studies. For the purposes of this review, stance phase AIPP models have been categorized as either lumped parameter or roll-over shape based.

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Local dynamic stability of amputees wearing a torsion adapter compared to a rigid adapter during straight-line and turning gait

Cited by 23 publications

References 29 publications

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Prosthetic interventions for people with transtibial amputation: Systematic review and meta-analysis of high-quality prospective literature and systematic reviews

Prosthesis preference is related to stride-to-stride fluctuations at the prosthetic ankle

Stance phase mechanical characterization of transtibial prostheses distal to the socket: A review

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