https://www.physio-pedia.com/images/5/5e/Gailey_AMP_Arch_of_Phys_Med_Rehab_2002-3.pdf

The Amputee Mobility Predictor: An instrument to assess determinants of the lower-limb amputee's ability to ambulate

http://opmarketing.com/storage/Research%20EncyclOPedia/Microprocessor%20Knees/Hafner-%20APMR%202007.pdf

Evaluation of Function, Performance, and Preference as Transfemoral Amputees Transition From Mechanical to Microprocessor Control of the Prosthetic Knee

INTRODUCTION Lower-limb amputees must relearn basic ambulatory skills to successfully function within the community. The two primary concerns for lower-limb amputees are comfort and mobility [1]. Despite continuous advances in prosthetic technology, 55 percent of amputees report they are unable to use their prosthesis to the extent they desire [2]. Most transfemoral (TF) amputees wear a noncomputerized prosthetic knee that incorporates friction, pneumatic, or hydraulic swing phase control. These devices are thought to be limited because the resistance setting that controls the rate of knee extension during swing remains constant and is therefore only optimal at specific walking speeds, which results in nonoptimal kinematics at a complete range of speeds. In addition, these non-adaptive, mechanically passive devices do not incorporate adaptive stance phase control, which requires the amputee Abbreviations: %BW = percent body weight, CWS = controlled walking speed, OHS = opposite heel strike, SD = standard deviation, SSWS = self-selected walking speed, TF = transfemoral, VGRF = vertical ground reaction force. to lock the knee mechanism in full extension during stance to avoid buckling. These limitations result in gait asymmetries [3-4], such as increased prosthetic swing phase knee flexion and decreased prosthetic stance phase knee flexion, which may contribute to such problems as increased metabolic cost [5] and secondary disability [6-8]. Therefore, further developments in prosthetic technology are needed to normalize amputee ambulation and minimize gait asymmetries. Past research has suggested that many challenges associated with TF-amputee ambulation are caused by gait asymmetries associated with stance phase kinetics [3-4,6]. For example, previous research demonstrated that amputee subjects had decreased loading on the prosthetic limb with increased loading on the intact limb compared with control subjects [9]. The higher forces on the intact limb may result from the lack of damping of the prosthetic knee during stance because of a decrease in prosthetic knee flexion, which causes excessive rise of the center of mass over the prosthetic limb [4-5]. The high forces shown to occur at the intact limb are thought to lead to pain and joint degeneration, which explains why TF amputees have a higher incidence of degenerative arthritis in their intact limbs compared with non-disabled subjects [6-8]. Specifically, coronal knee moments have been shown to be a major determinant of the load distribution during walking, with a significant correlation between external knee-adduction moment and bone distribution between the proximal-medial and proximallateral plateaus [10]. Sagittal-plane moments have also been shown to play a role in determining the overall compressive load on the knee joint. Therefore, both coronal and sagittal-plane knee moments are relevant measures when the relationship between loading and knee osteoarthritis is studied [10]. In a recent study of transtibial amputees, researchers measured coronal knee moments and found an increase in abduction moment of 56 percent compared with the prosthetic limb and 10 percent compared with the control group [11]. Despite the high occurrence of osteoarthritis in the intact limb of TF amputees, few studies have examined coronal knee moments [12]. In addition to the inability to use normal stance phase knee flexion to maintain stability and avoid inadvertent knee buckling [3], TF amputees have another common asymmetry: increased hip extensor activity for assisting stabilization of the knee. The increased hip power output may help compensate for the lack of ankle power generated by the prosthetic foot [13]. Mechanical power measurements, defined as the product of the joint moment of force and the angular velocity, are important measures of muscle function during concentric and eccentric phases of gait [14]. Therefore, increased power measurements may result in increased fatigue and secondary disability. …

/pdf/kinematic-and-kinetic-comparisons-of-transfemoral-amputee-igsgscwpoi.pdf

Kinematic and kinetic comparisons of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees.

A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various prosthetic components. No clear clinical consensus seems to be given on the precise prescription criteria. To obtain information about different prosthetic components and daily functioning of amputees with a prosthesis, we performed a systematic literature search. The quality of the studies was assessed with the use of predetermined methodological criteria. Out of 356 potentially relevant studies, 40 studies eventually qualified for final methodological analysis and review. Four satisfied all the criteria and were classified as A-level studies, 26 as B-level, and 10 studies as C-level studies. Despite a huge amount of literature, our formal clinical knowledge had considerable gaps concerning the effects of different prosthetic components and their mechanical characteristics on human functioning with a lower-limb prosthesis. Therefore, with regard to prosthetic guideline development, we must still largely rely on clinical consensus among experts. The integration of knowledge from research with the expert opinion of clinical professionals and the opinions and wishes of consumers can form a solid base for a procedure on guideline development for prosthetic prescription.

/pdf/a-systematic-literature-review-of-the-effect-of-different-1v2wnqiptw.pdf

A systematic literature review of the effect of different prosthetic components on human functioning with a lower-limb prosthesis

The functional differences between persons with amputation who are classified as Medicare Functional Classification Level (MFCL)-2 and -3 include the abilities to walk at various cadences and to negotiate environmental barriers outside the home. This study compared the effect of active microprocessor control and passive mechanical control of the prosthetic knee on function and safety in 17 subjects with transfemoral amputation (8 MFCL-2 and 9 MFCL-3). Assessed functional tasks included hill and stair descent, an attentional demand task, and an obstacle course. Self-reported measures included concentration, multitasking ability, and numbers of stumbles and falls. Active knee control was associated with significant improvements (p < 0.05) in hill and stair gait, speed (hills, obstacle course, and attentional demand task), and ability to multitask while walking for both cohorts. MFCL-2 subjects also reported a significant reduction (p < 0.01) in uncontrolled falls. Over the study, 50% of MFCL-2 subjects and 33% of MFCL-3 subjects transitioned to a higher MFCL. Results suggest that active knee control improves function and reduces the frequency of adverse events in a population that is at risk for falls. Use of active knee control may allow persons with amputation to expand their functional domain, transition to a higher MFCL, and access additional prosthetic options.

/pdf/differences-in-function-and-safety-between-medicare-3uspcvrida.pdf

Differences in function and safety between Medicare Functional Classification Level-2 and -3 transfemoral amputees and influence of prosthetic knee joint control

Benchmark data for lower limb amputees is often limited to young subjects who have had their amputations as the result of trauma. The majority of trans-tibial amputees rehabilitated are, however, elderly vascular amputees who may have different gait characteristics than their younger counterparts. Without biomechanical analyses to provide such benchmark data for this group it is not possible to compare the effects of different rehabilitation programmes, gait training regimens, or prosthetic devices.Twenty elderly vascular trans-tibial amputees rehabilitated at The Queen Elizabeth Centre, Ballarat, Australia and at least six months post-amputation were measured in respect of kinetic and kinematic parameters, and relationships between gait speed, consistency, and function were demonstrated. Further, an unexplained vertical ground reaction force pattern was demonstrated in faster, more functional amputees.

/pdf/benchmark-data-for-elderly-vascular-trans-tibial-amputees-1pjfkrki8s.pdf

Benchmark data for elderly, vascular trans-tibial amputees after rehabilitation

Since the time required for a person with an amputation to become familiarized with a prosthesis after a change of a component is not known, the gait of a single subject, a man with a through-knee amputation, was examined with two different knee mechanisms interchanged in the same prosthesis. Several parameters were analyzed to determine when the subject's gait had stabilized sufficiently to permit confident assessment of the appropriateness of the knee mechanisms. At least one week of functional walking was required before a clinical decision could be made about the suitability of the component. For the purposes of research, it was deemed preferable to try knee mechanisms for at least 3 weeks to be sure pertinent gait parameters stabilized.

/pdf/establishment-of-consistent-gait-after-fitting-of-new-1qn5d18hj5.pdf

Establishment of consistent gait after fitting of new components.

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Benchmark data for elderly, vascular trans-tibial amputees after rehabilitation

Establishment of consistent gait after fitting of new components.