Exercise Physiology: Energy, Nutrition and Human Performance

This paper presents a self-contained powered knee and ankle prosthesis, intended to enhance the mobility of transfemoral amputees. A finite-state based impedance control approach, previously developed by the authors, is used for the control of the prosthesis during walking and standing. Experiments on an amputee subject for level treadmill and overground walking are described. Knee and ankle joint angle, torque, and power data taken during walking experiments at various speeds demonstrate the ability of the prosthesis to provide a functional gait that is representative of normal gait biomechanics. Measurements from the battery during level overground walking indicate that the self-contained device can provide more than 4500 strides, or 9 km, of walking at a speed of 5.1 km/h between battery charges.

Preliminary Evaluations of a Self-Contained Anthropomorphic Transfemoral Prosthesis

Objective: t o investigate factors that predict walking with a prosthesis after lower limb amputation. Design: Systematic literature review. Methods: A computer-aided literature search of MeDliNe, eMBASe, ciNAHl and the cochrane library was per formed to identify studies published up to August 2007 that investigated factors that predicted walking ability after lower limb amputation. Results: A total of 57 studies were selected. Predictors of good walking ability following lower limb amputation include cognition, fitness, ability to stand on one leg, independence in activities of daily living and pre-operative mobility. longer time from surgery to rehabilitation and stump problems are predictors of poor outcome. the impact of the cause of amputation on walking varies between studies. in gener al, unilateral and distal amputation levels, and younger age were predictive of better walking ability. Sex probably does not have a significant influence on walking ability. Conclusion: the heterogeneity of methods and outcome measures used in the identified studies make comparison difficult and, in part, explains conflicting conclusions in relation to predictive factors. Further investigation of predictive factors is needed to estimate walking potential more accurately and guide targeting of modifiable factors to optimize outcome after lower limb amputation.

/pdf/predicting-walking-ability-following-lower-limb-amputation-a-1m51puwvc0.pdf

Predicting walking ability following lower limb amputation: a systematic review of the literature.

Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to above-knee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue1–4. The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing leg5,6. To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes7 in the remaining tibial nerve (ClinicalTrials.gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback. A new prosthetic leg that can transmit sensory signals via implanted electrodes is shown to restore meaningful sensory feedback that improves walking performance and lowers phantom limb pain during use in two human lower-limb amputees.

/pdf/sensory-feedback-restoration-in-leg-amputees-improves-1dt9nm9wk8.pdf

Sensory feedback restoration in leg amputees improves walking speed, metabolic cost and phantom pain.

Determination of preferred walking speed on treadmill may lead to high oxygen cost on treadmill walking

Energy cost of walking measurements in subjects with lower limb amputations: a comparison study between floor and treadmill test.

http://opmarketing.com/storage/Research%20EncyclOPedia/Transfemoral/Tabellesi-%20TF%20Energy%20MAS.pdf

Energy cost of walking in transfemoral amputees: Comparison between Marlo Anatomical Socket and Ischial Containment Socket

AIM The aim of this study was to evaluate the prognostic factors for rehabilitation outcome in bilateral dysvascular lower limb amputees, specifically to ascertain how the stump condition can influence the mobility outcome. METHODS A retrospective study of 30 selected bilateral above-knee amputees for vascular disease was carried out. Barthel Index (BI) was given and stump condition was assessed at admission and at discharge. Influence of age, comorbidities and stump condition on effectiveness of BI was evaluated. Locomotor Capability Index (LCI) was performed at discharge. Influence of stump problems (pain, flexion, pain with flexion) on LCI was evaluated. RESULTS At discharge, 25 patients were able to ambulate. Age and pathological conditions of stumps correlated negatively with BI effectiveness. LCI values were higher for patients with ideal stumps and lower for patients with combined stump pain and flexion deformities. Post hoc analysis showed that the principal factor negatively influencing the LCI score was the presence of stump flexion deformities. CONCLUSIONS In our homogeneous group of bilateral amputees, age reduced the possibility of improving the level of autonomy. Good stump quality is one of the major determinants of mobility outcome. Efforts should be made to minimize stump complications. In particular, incorrect positioning of the stump, which is responsible for hip flexor retraction, should be avoided after surgery.

Prognostic factors in prosthetic rehabilitation of bilateral dysvascular above-knee amputee: is the stump condition an influencing factor?

https://www.archives-pmr.org/article/S0003-9993(06)00327-3/pdf

Functional status and factors influencing the rehabilitation outcome of people affected by above-knee amputation and hemiparesis.

Trans-tibial amputation is a common sequela of vascular complications caused by diabetes mellitus [1]. Using prosthesis is the only way for patients with lower-limb amputation to regain the ability...

Trans-tibial prosthesization in large area of residual limb wound: Is it possible? A case report

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