Measurement of Knee Center Alignment Trends in a National Sample of Established Users of the Otto Bock C-Leg Microprocessor-Controlled Knee Unit

Willingham, Laura L.; Buell, Noelle C.; Allyn, Kate J.; Hafner, Brian J.; Smith, Douglas G.

doi:10.1097/00008526-200407000-00002

Cited by 10 publications

(6 citation statements)

References 3 publications

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“…One potential reason that the early flexion was not measured across all the studies may be because of the alignment of the MPK. Willingham et al suggested that MPKs may be aligned following traditional methods with the GRF too anterior to the knee-joint center, thus limiting their ability to achieve this stance flexion [157]. Additional research would be needed to explore this hypothesis.…”

Section: Gait Mechanicsmentioning

confidence: 99%

“…In the future, improved standards for documenting and reporting prosthetic-limb alignment may allow readers to better assess the influence of alignment on the study outcomes. While several publications have described the use of tools that have been developed to aid in the quantification of lower-limb prosthetic alignment [82,102,157,[165][166], their regular integration into comparative research protocols or publications has yet to occur.…”

Section: Gait Mechanicsmentioning

confidence: 99%

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Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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Abstract-Microprocessor-controlled prosthetic knees (MPKs) have been developed as an alternative to non-microprocessorcontrolled knees (NMPKs) to address challenges facing individuals with lower-limb loss. A body of scientific literature comparing MPKs and NMPKs exists but has yet to be critically appraised. Therefore, we conducted a systematic review to examine outcomes associated with the use of these interventions among individuals with transfemoral limb loss. A search of biomedical databases identified 241 publications, of which 27 met the inclusion and exclusion criteria and were reviewed for methodological quality and content. We developed 28 empirical evidence statements (EESs) in 9 outcome categories (metabolic energy expenditure, activity, cognitive demand, gait mechanics, environmental obstacle negotiation, safety, preference and satisfaction, economics, and health and quality of life) based on findings in the literature. The level of evidence supporting these EESs varied due to quantity, quality, and consistency of the results. EESs supported by a moderate level of evidence that noted significant differences between MPKs and NMPKs were derived in five of the nine outcome categories. The results from this review suggest that evidence exists to inform clinical practice and that additional research is needed to confirm existing evidence and better understand outcomes associated with the use of NMPKs and MPKs.Key words: amputation, artificial limb, function, gait, knee, microprocessor, outcome, preference, rehabilitation, safety. Abbreviations: AAOP = American Academy of Orthotists andProsthetists, ABC = Activities-specific Balance Confidence, CWS = controlled walking speed, DLW = doubly labeled water, EBP = evidence-based practice, EES = empirical evidence statement, EV = external validity, GRF = ground reaction force, HAI = Hill Assessment Index, HRQL = health-related quality of life, IV = internal validity, LLL = lower-limb loss, MFCL = Medicare Functional Classification Level, MP = microprocessor, MPC = microprocessor control, MPK = microprocessor-controlled prosthetic knee, MRPP = Montreal Rehabilitation Performance Profile, NMPK = non-microprocessor-controlled prosthetic knee, O 2 = oxygen, O&P = orthotic and prosthetic, PAEE = physical activity-related energy expenditure, PCBS = Prosthetic Cognitive Burden Scale, PCI = physiological cost index, PEQ = Prosthesis Evaluation Questionnaire, PEQ-A = PEQ Addendum, PRO = patient-reported outcome, QALY = quality adjusted life year, QOL = quality of life, RPE = rating of perceived exertion, SAI = Stair Assessment Index, SF-36 = 36-Item Short-Form Health Survey, SOT = sensory organization test, SSWS = selfselected walking speed, SSC = State of the Science Conference, TDEE = total daily energy expenditure, TFLL = transfemoral limb loss.

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Section: Gait Mechanicsmentioning

confidence: 99%

Section: Gait Mechanicsmentioning

confidence: 99%

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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“…TM ) posture system (Otto Bock, Duderstadt, Germany). 22 Participants then received training in their C-Leg Compact and a three-month accommodation period prior to the second laboratory testing session. Training consisted of five to seven one-hour sessions with a physical therapist which included education to enhance each participant's understanding of the capabilities of the prosthesis, and practice on stairs, ramps, curbs and uneven surfaces.…”

Section: C-leg Compact Fitting Adjustment Training and Accommodationmentioning

confidence: 99%

Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees

Burnfield

Eberly

Gronely

et al. 2012

Prosthetics &Amp; Orthotics International

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Background: Microprocessor controlled prosthetic knees (MPK) offer opportunities for improved walking stability and function, but some devices' swing phase features may exceed needs of users with invariable cadence. One MPK offers computerized control of only stance (C-Leg Compact). Objective: To assess Medicare Functional Classification Level K2 walkers' ramp negotiation performance, function and balance while using a non-MPK (NMPK) compared to the C-Leg Compact. Study Design: Crossover. Methods: Gait while ascending and descending a ramp (stride characteristics, kinematics, electromyography) and function were assessed in participant's existing NMPK and again in the C-Leg Compact following accommodation. Results: Ramp ascent and descent were markedly faster in the C-Leg Compact compared to the NMPK (p ≤ 0.006), owing to increases in stride length (p ≤ 0.020) and cadence (p ≤ 0.020). Residual limb peak knee flexion and ankle dorsiflexion were significantly greater (12.9° and 4.9° more, respectively) during single limb support while using the C-Leg Compact to descend ramps. Electromyography (mean, peak) did not differ significantly between prosthesis. Function improved in the C-Leg Compact as evidenced by a significantly faster Timed Up and Go and higher functional questionnaire scores. Conclusions: Transfemoral K2 walkers exhibited significantly improved function and balance while using the stance-phase only MPK compared to their traditional NMPK. Clinical relevanceInstability, reduced function and falls are common in deconditioned transfemoral amputees. Selection and use of prosthetic componentry that promotes greater stability in more challenging environments is essential to improve the safety, function, quality of life and independence of individuals functioning at the K2 walking level.

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“…The sole evidence statement generated in this review on this topic indicated that peak stance phase knee flexion was equivalent between swing and stance MPKs and NMPKs (EES 4-F). Willingham et al 156 suggested that MPKs may be aligned following traditional methods with the ground reaction force too anterior to the knee joint center, thus limiting their ability to achieve this ''stance flexion.'' This empirical evidence statement (EES 4-F) was not well supported by the literature as the results varied between studies.…”

Section: Gait Mechanicsmentioning

confidence: 99%

“…Laboratory settings allow investigators to control confounding variables and improve the quality of the scientific experiments. While several publications have described the use of tools that have been developed to aide in the quantification of lower limb prosthetic alignment, 81,101,156,164,165 their regular integration to comparative research protocols or publications has yet to occur. The results gathered from testing in such environments may not generalize well to real world situations.…”

Section: Gait Mechanicsmentioning

confidence: 99%

Outcomes Associated with the Use of Microprocessor-Controlled Prosthetic Knees among Individuals with Unilateral Transfemoral Limb Loss

Sawers

Hafner

2013

JPO Journal of Prosthetics and Orthotics

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Microprocessor-controlled prosthetic knees (MPKs) have been developed as an alternative to non-microprocessor-controlled knees (NMPKs) to address challenges facing individuals with lower limb loss. A body of scientific literature comparing MPKs and NMPKs exists, but has yet to be critically appraised. Therefore, a systematic review was conducted to examine outcomes associated with use of these interventions among individuals with transfemoral limb loss. A search of biomedical databases identified 241 publications. Twenty-seven met the inclusion/exclusion criteria and were reviewed for methodological quality and content. Twenty-eight evidence statements, in nine outcome categories (Metabolic Energy Expenditure, Activity, Cognitive Demand, Gait Mechanics, Environmental Obstacle Negotiation, Safety, Preference & Satisfaction, Economics, and Health & Quality of Life) were developed based on findings in the literature. The level of evidence supporting these statements varied due to quantity, quality, and consistency of the results in the literature. Evidence statements supported by a moderate level of evidence that noted significant differences between MPKs and NMPKs were derived in five of the nine outcome categories. The results from this review suggest that evidence exists to inform clinical practice, and that additional research is needed to confirm existing evidence and better understand outcomes associated with use of NMPKs and MPKs. (J Prosthet Orthot. 2013;25:P4YP40.) non-digit) loss of the limb. More than 42% of all amputations are attributed to major limb loss, with the vast majority of those (i.e., approximately 94%) 1 occurring in the lower limb. Given the importance of the lower limb to balance, transfer, and ambulation activities, lower limb loss (LLL) negatively affects an individual's functional ability at home and in the community. 4Y9 For example, a 2006 systematic review of walking ability following LLL noted that, while 56 to 97% of individuals regain walking ability following LLL, only 26 to 62% regain the ability to ambulate outdoors. 4 This specific limitation seems critical, as an inability to ambulate outside of the home may impede participation in both vocational and avocational activities and increase individuals' reliance upon physical, personal, and financial assistance.The physiological and functional challenges associated with LLL are also exacerbated at more proximal levels of limb loss, 8,10Y13 as evidenced by significantly fewer individuals with transfemoral limb loss (TFLL) than individuals with transtibial limb loss who are reported to achieve household (50% vs. 66%, p = 0.007) or community (29% vs. 54%, p = 000) ambulation. 8 Limb loss at the transfemoral level, when compared to limb loss at more distal levels, has also been reported to be associated with a decreased frequency of prosthetic fitting, 7,14,15 and an increased frequency of back, knee, and hip pain, 16Y19 obesity, 20 and osteoarthritis. 17,21 These medical issues may ultimately contribute to the extended period of ...

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Measurement of Knee Center Alignment Trends in a National Sample of Established Users of the Otto Bock C-Leg Microprocessor-Controlled Knee Unit

Cited by 10 publications

References 3 publications

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees

Outcomes Associated with the Use of Microprocessor-Controlled Prosthetic Knees among Individuals with Unilateral Transfemoral Limb Loss

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