Quantifying accommodation to prosthesis interventions in persons with lower limb loss

Fiedler, Goeran; Zhang, Xueyi

doi:10.1016/j.gaitpost.2016.08.016

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…Contrary to previous work and recommendations, the additional acclimation did not markedly influence the walk test results. 16,21 Finally, although the ATK improved mobility performance and decreased instances of knee instability, a cosmetically acceptable finish was more difficult to achieve. Hence, the provision of prosthetic technology to places such as Cambodia must consider not only functionality but also cosmesis.…”

Section: Discussionmentioning

confidence: 99%

“…To allow for further acclimation, participants used the ATK knee prosthesis at home for at least 1 month. 21 Data collection was repeated after 1 month of use (ATK1). During this visit, participants were given the choice of reverting to the ICRC knee or continuing with the ATK and attending follow-up data collection sessions 6 and 12 months later.…”

Section: Methodsmentioning

confidence: 99%

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Functional outcomes and user preferences of individuals with transfemoral amputations using two types of knee joints in under-resourced settings

Andrysek

Michelini

Eshraghi

et al. 2021

Prosthetics &Amp; Orthotics International

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Background: Information relating to prosthetic performance can inform clinical practice and improve patient outcomes in underresourced countries.Objectives: The main goal of this study was to compare functional outcomes and user preferences of individuals with transfemoral amputations using common types of knee joints in an under-resourced country. Study design: Prospective, longitudinal, before and after trial. Methods: Twenty individuals with unilateral transfemoral amputations from a center in Cambodia transitioned from a commonly used single-axis manually locking knee International Committee of the Red Cross (ICRC) to a more advanced multiaxis knee joint with stance control All-Terrain Knee (ATK). Data were collected for the ICRC knee joint and the ATK immediately after fitting, after acclimation, and as part of a long-term follow-up. A timed walk test assessed walking distance and efficiency. Mobility and user-preferences were evaluated through questionnaires. Results: Distance during the timed walk test was significantly higher for the ATK compared with ICRC (P , 0.001), with functional gains retained at follow-up. No differences were found for gait efficiency and the mobility questionnaires. All participants, except one, preferred the ATK prosthesis. Benefits included greater knee stability and fewer perceived knee collapses; however, some disliked the appearance of the ATK. Conclusions: The findings suggest positive outcomes with prosthetic services in under-resourced regions and the ICRC system, as well as the potential for improved functional outcomes with more advanced multiaxis knee components.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Functional outcomes and user preferences of individuals with transfemoral amputations using two types of knee joints in under-resourced settings

Andrysek

Michelini

Eshraghi

et al. 2021

Prosthetics &Amp; Orthotics International

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“…That four of five participants were accustomed to using microprocessor-controlled devices may have further increased the requirement for acclimation. Acclimation was not quantified and comparison with any reported acclimation periods empirically tested in other individuals (see e.g., [ 30 ] for technique and sample data) would not be appropriate. However, the trends in the variables we report, which were evident regardless of the adoption of compensatory strategies that varied across participants and across conditions, lend weight to our findings.…”

Section: Discussionmentioning

confidence: 99%

Knee Swing Phase Flexion Resistance Affects Several Key Features of Leg Swing Important to Safe Transfemoral Prosthetic Gait

Kent

Arelekatti

Petelina

et al. 2021

IEEE Trans. Neural Syst. Rehabil. Eng.

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We systematically investigate in-vivo the effect of increasing prosthetic knee flexion damping on key features of the swing phase of individuals with transfemoral amputation during walking. Five experienced prosthesis users walked using a prototype device in a motion capture laboratory. A range of interchangeable hydraulic rotary dampers was used to progressively modify swing phase flexion resistance in isolation. Toe clearance (TC; vertical distance toe to floor), effective leg length (ELL; distance hip to toe), and knee flexion angle during swing phase were computed, alongside the sensitivities of vertical toe position to angular displacements at the hip, knee and ankle. Key features of these profiles were compared across 5 damping conditions. With higher damping, knee extension occurred earlier in swing phase, promoting greater symmetry. However, with implications for toe catch, minimum TC reduced, and minimum TC and maximum ELL occurred earlier; temporally closer to mid-swing, when the limb must pass the stance limb. Further, TC became less sensitive to changes in hip flexion, suggesting a lesser ability to control toe clearance without employing proximal or contralateral compensations. There is a trade-off between key features related to gait safety when selecting an appropriate resistance for a mechanical prosthetic knee. In addition to highlighting broader implications surrounding swing phase damping selection for the optimization of mechanical knees, this work reveals design considerations that may be of utility in the formulation of control strategies for computerized devices.

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“…The same study prosthetist performed all work on subjects' prostheses. Details of the protocol design have been described previously [17].…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Gait Variable Change over Time as Transtibial Amputees Adapt to a New Prosthesis Foot

Zhang

Fiedler

Liu

2019

BioMed Research International

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A variety of prescribed accommodation periods have been used in published prosthesis intervention studies that have examined biomechanical outcomes. Few investigators included repeated measurements in their study design, leaving questions as to how measured outcomes change as amputees acclimate to a new prosthesis. This paper is the product of our investigation as to whether measured gait variables were affected by the duration of accommodation period, and to assess the relationship between measured outcomes and the subjective perception of the participants. A sample of transtibial amputees were recruited for this study. Gait data was collected by wearable sensor repeatedly, starting immediately after fitting the interventional foot and extending over a subsequent four days. Participants indicated their perceived accommodation quality on a visual analog scale (VAS). A total of twelve commonly used spatiotemporal gait parameters were analyzed. Friedman tests were used to determine overall differences across time points in both early (one hour) and late (day two through five) accommodation phases, for each gait variable. Statistically significant changes across the early phase were found for variables gait speed χ2(2)=8.000, p=0.018, cadence χ2(2)=7.185, p=0.028, and double support time on the sound side χ2(2)=8.615, p=0.013. Across days two through five, no gait variable significantly changed. VAS scores correlated strongly with step count (r=1.000, p<0.001) and cadence (r=0.857, p=0.014). Longer accommodation periods resulted in less deviations of gait variables for the clinical assessment in the process of prosthetic rehabilitation. Trying out prosthetic interventions for less than one hour has yielded unreliable outcomes.

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Quantifying accommodation to prosthesis interventions in persons with lower limb loss

Cited by 8 publications

References 6 publications

Functional outcomes and user preferences of individuals with transfemoral amputations using two types of knee joints in under-resourced settings

Functional outcomes and user preferences of individuals with transfemoral amputations using two types of knee joints in under-resourced settings

Knee Swing Phase Flexion Resistance Affects Several Key Features of Leg Swing Important to Safe Transfemoral Prosthetic Gait

Evaluation of Gait Variable Change over Time as Transtibial Amputees Adapt to a New Prosthesis Foot

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