Performance of the CYBERLEGs motorized lower limb prosthetic device during simulated daily activities

2021 ◽  
Vol 2 ◽  
Author(s):  
Jo Ghillebert ◽  
Joost Geeroms ◽  
Louis Flynn ◽  
Sander De Bock ◽  
Renée Govaerts ◽  
...  
Keyword(s):  
Lower Limb ◽  
Stride Length ◽  
Cognitive Effort ◽  
Stair Climbing ◽  
Daily Activities ◽  
Human Gait ◽  
Limb Amputation ◽  
Future Research ◽  
Experimental Session ◽  
Adaptation Period

Abstract Background The CYBERLEGs-gamma (CLs-ɣ) prosthesis has been developed to investigate the possibilities of powerful active prosthetics in restoring human gait capabilities after lower limb amputation. Objective The objective of this study was to determine the performance of the CLs-ɣ prosthesis during simulated daily activities. Methods Eight participants with a transfemoral amputation (age: 55 ± 15 years, K-level 3, registered under: NCT03376919) performed a familiarization session, an experimental session with their current prosthesis, three training sessions with the CLs-ɣ prosthesis and another experimental session with the CLs-ɣ prosthesis. Participants completed a stair-climbing-test, a timed-up-and-go-test, a sit-to stand-test, a 2-min dual-task and a 6-min treadmill walk test. Results Comparisons between the two experimental sessions showed that stride length significantly increased during walking with the CLs-ɣ prosthesis (p = .012) due to a greater step length of the amputated leg (p = .035). Although a training period with the prototype was included, preferred walking speed was significantly slower (p = .018), the metabolic cost of transport was significantly higher (p = .028) and reaction times significantly worsened (p = .012) when walking with the CLs-ɣ compared to the current prosthesis. Conclusions It can be stated that a higher physical and cognitive effort were required when wearing the CLs-ɣ prosthesis. Positive outcomes were observed regarding stride length and stair ambulation. Future prosthetics development should minimize the weight of the device and integrate customized control systems. A recommendation for future research is to include several shorter training periods or a prolonged adaptation period.

Dual-task standing and walking in people with lower limb amputation: A structured review

2018 ◽  
Vol 42 (6) ◽  
pp. 652-666 ◽  
Author(s):  
Sara J Morgan ◽  
Brian J Hafner ◽  
Deborah Kartin ◽  
Valerie E Kelly
Keyword(s):  
Task Performance ◽  
Dual Task ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Future Research ◽  
Eligibility Criteria ◽  
Limited Mobility ◽  
Study Results ◽  
Dual Task Performance

Background: People with lower limb amputation report the need to concentrate on walking. Dual-task paradigms are often used to study such interactions between cognition and the control of balance and gait in people with lower limb amputation. Objectives: To summarize evidence related to dual-task standing and walking in people with lower limb amputation and discuss implications for future research. Study design: Structured review. Methods: A structured search was completed in PubMed, CINAHL, and Web of Science from database inception to May 2017. Eligible articles were in English, included participants with lower limb amputation, and assessed dual-task standing or walking. Study information was extracted by one reviewer and assessed for accuracy by a second. Results: A total of 12 articles met eligibility criteria. Seven examined differences in dual-task standing or walking, and five assessed dual-task walking across microprocessor-controlled and non-microprocessor-controlled prosthetic knee conditions. Conclusion: Results suggest that (1) dual-task interference in standing is greater for people with lower limb amputation than non-amputees and (2) the use of microprocessor-controlled knees improves dual-task performance for people with limited mobility compared to non-microprocessor-controlled knees. The small number of studies, diversity of dual-task methods, and methodological limitations challenge the synthesis of study results. Future research should assess specific clinical characteristics that can affect dual-task performance in people with lower limb amputation. Clinical relevance Understanding how people with lower limb amputation use increased attention in balance and gait to compensate for limb loss can inform prosthetic interventions and training. Dual-task research suggests that people with amputation use increased cognitive control for standing compared to controls and microprocessor-controlled knees improve dual-task walking in people with limited mobility.

Self-directed usage of an in-home exergame after a supervised telerehabilitation training program for older adults with lower-limb amputation

2020 ◽  
Vol 44 (2) ◽  
pp. 52-59
Author(s):  
Gordon Tao ◽  
William C Miller ◽  
Janice J Eng ◽  
Heather Lindstrom ◽  
Bita Imam ◽  
...  
Keyword(s):  
Clinical Supervision ◽  
Lower Limb ◽  
Secondary Analysis ◽  
Exercise Duration ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Experimental Session ◽  
Supervised Training ◽  
Session Time ◽  
Home Based

Background: While home-based exergames help overcome accessibility barriers to rehabilitation, it is unclear what constitutes effective intervention design in using exergames to support self-efficacy and engagement. Objective: Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation. Study design: Secondary analysis of a multi-site parallel evaluator-masked randomized control trial. Methods: WiiNWalk uses the WiiFit and teleconferencing for in-home group-based exergame therapy with clinical supervision. Participants engaged in a 4-week supervised training phase followed by a 4-week unsupervised phase in experimental (WiiNWalk) and attention control groups. Usage between phases and between groups was compared using unsupervised/supervised ratio of session count (over 4 weeks) and session time (mean min/session over 4 weeks) for each phase. Results: Participants: n=36 experimental, n=28 control, unilateral lower-limb amputation, age > 50 years, prosthesis usage ≥ 2 hours/day. Session count ratio unsupervised/supervised, median and interquartile range (IQR), was less than parity ( p<0.01) for experimental (0.25, IQR 0.00 -0.68) and control (0.18, IQR 0.00 -0.67) groups, with no different between groups ( p=0.92). Experimental session time unsupervised/supervised showed consistency (1.12, IQR 0.80 -1.41) between phases ( p=0.24); control showed lower (0.76, IQR 0.57 -1.08) ratios compared to experimental ( p=0.027). Conclusions: Unsupervised exercise duration remained consistent with supervised, but frequency was reduced. Social and clinical guidance features may remain necessary for sustained lower-limb amputation exergame engagement at home. Clinical relevance This study provides context regarding when prosthesis users are more likely to use exergames such as Wii Fit for exercise therapy. Clinicians may consider our results when applying exergames in their practice or when developing new exergame intervention strategies.

Lower Limb Kinetic And Energetic Factors Associated With Stride Length In Healthy Human Gait

2009 ◽  
Vol 41 ◽  
pp. 3
Author(s):  
Paul DeVita ◽  
Patrick Rider ◽  
Tim Copple ◽  
Jonathan Patterson ◽  
Tibor Hortobagyi
Keyword(s):  
Lower Limb ◽  
Stride Length ◽  
Human Gait ◽  
Healthy Human ◽  
Factors Associated

Importance of secondary conditions in rehabilitation medicine

2012 ◽  
Vol 153 (49) ◽  
pp. 1937-1947
Author(s):  
Lajos Kullmann
Keyword(s):  
Lower Limb ◽  
Rehabilitation Medicine ◽  
International Classification ◽  
International Classification Of Functioning ◽  
Limb Amputation ◽  
Future Research ◽  
Disability And Health ◽  
Secondary Conditions ◽  
Cord Injury

The author interprets disability on the basis of the “International Classification of Functioning, Disability and Health (ICF)”. In this review the applied method is a purpose oriented, restricted survey of continuously increasing articles published during the last two decades. Definition and interpretation of secondary conditions are based on the cited international classification. It is noted that secondary conditions frequently develop during acute care and usually require rehabilitation. Significance of secondary conditions in rehabilitation is highlighted by selected examples of traumatic spinal cord injury, stroke, lower limb amputation and intellectual disabilities. The author states that there is an insufficiency of presently available knowledge and raises the need for the use of the International Classification of Functioning, Disability and Health as foundation of future research. Orv. Hetil., 2012, 153, 1937–1947.

scholarly journals Cycling in people with a lower limb amputation

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Jutamanee Poonsiri ◽  
Rienk Dekker ◽  
Pieter U. Dijkstra ◽  
Juha M. Hijmans ◽  
Jan H. B. Geertzen
Keyword(s):  
The Netherlands ◽  
Median Duration ◽  
Lower Limb ◽  
Odds Ratio ◽  
Lower Limb Amputation ◽  
Barriers And Facilitators ◽  
Limb Amputation ◽  
Future Research ◽  
Personal Motivation ◽  
Underlying Diseases

Abstract Background To evaluate cycling participation and identify barriers and facilitators related to cycling participation in people with a lower limb amputation (LLA) in the Netherlands. Methods A questionnaire was sent to adults with a LLA between March and August 2019 to obtain information regarding prosthesis, individual’s characteristics, amputation, cycling barriers and facilitators, and prosthetic satisfaction. The questionnaires were distributed via 8 orthopedic workshops, post and were given directly. To find cycling predictors, variables associated with cycling (p < 0.1) were entered into a logistic regression analysis. Non-significant variables were removed manually. Results Participants (n = 207, 71% males) had a mean age of 62.0 ± 13.0 years. The most frequent level of amputation was transtibial (42%), and trauma was the most frequent cause of amputation (43%). After the LLA, 141 participants (68%) cycled for recreation (80%), physical fitness (74%), and transport (50%). In the past six months, cyclists cycled for recreation (79%) and transport (66%). Most cycled less than once a day. Recreational cyclists cycled alone (75%) for a median duration of 45 min or 14 km per ride. Cyclists with a transportation purpose usually cycled to go shopping (80%) or to visit friends (68%), with a median duration of 20 min or five kilometers per ride. Cyclists reported more facilitators (median (IQR) = 5 (3, 7) than non-cyclists 0 (0, 3). The majority of cyclists reported a positive attitude toward cycling (89%) and cycled because of health benefits (81%). A dynamic foot (odds ratio: 5.2, 95% CI 2.0, 13.3) and a higher number of facilitators (odds ratio: 1.3, 95% CI 1.2, 1.5) positively predicted cycling, whereas the presence of other underlying diseases (odds ratio: 0.4, 95% CI 0.2, 0.9) negatively predicted cycling (R2: 40.2%). Conclusion In the Netherlands, the majority of adults cycled after a LLA, mainly for recreational purposes. A dynamic foot, a higher number of facilitators, and no other underlying diseases increases the likelihood of cycling after a LLA. The results suggest that personal motivation and a higher mobility level could be the key to increasing cycling participation. Future research should determine the association between motivation, mobility levels, and cycling with a LLA.

REVIEW: HEMODYNAMIC STUDIES FOR LOWER LIMB AMPUTATION AND REHABILITATION

2015 ◽  
Vol 15 (04) ◽  
pp. 1530005 ◽  
Author(s):  
RUIQI DONG ◽  
WENTAO JIANG ◽  
MING ZHANG ◽  
AARON LEUNG ◽  
M. S. WONG
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Surgical Techniques ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Future Research ◽  
Flow State ◽  
Physical And Mental Health ◽  
Two Stages ◽  
Postoperative Problems

No matter what the reason and level of amputation are, amputees will face many complex postoperative problems and potential complications. From the perioperative stage to lengthy rehabilitation process, patients need comprehensive and cautious therapies to help them rebuild their physical and mental health. Although there is some scattered information, the achievements of hemodynamic study for lower limb amputation and rehabilitation have not been systematically classified and summarized. The purpose of this review is to introduce and discuss the hemodynamic issues in preoperative diagnosis, surgical techniques and postoperative problems in the past two decades. Whether from clinical or biomechanical perspective, the investigations of the former two stages have been relatively mature and gained some clear outcomes, even if some conclusions are conflicting and controversial. While in terms of the postoperative problems, such as the common pressure ulcers, DTI and muscle atrophy, there is a lack of vascular or blood flow state studies specifically for lower residual limb. Therefore, the future research focus of hemodynamics for lower limb amputation should probably be the detailed investigations on the relationships between various blood flow parameters and certain common complications. Although hemodynamic research has made some achievements at this stage, it is believed that more advanced and reliable techniques are pending for further explorations and developments.

scholarly journals Changes in Gait Variables in Patients with Intermittent Claudication

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Bogdan Pietraszewski ◽  
Marek Woźniewski ◽  
Ryszard Jasiński ◽  
Artur Struzik ◽  
Andrzej Szuba
Keyword(s):  
Intermittent Claudication ◽  
Lower Limb ◽  
Stride Length ◽  
External Rotation ◽  
Plantar Flexion ◽  
Arterial Disease ◽  
Healthy People ◽  
Human Gait ◽  
Gait Velocity ◽  
Flexion Extension

Objective. Intermittent claudication (IC) is a pathological symptom with a particular effect on human gait patterns. Therefore, analyzing these patterns can facilitate rehabilitation or treatment through comparison of the values of kinematic and kinetic variables of patients with the normal values of healthy people. Therefore, the aim of this study was to find differences in the values of gait variables between patients with IC and healthy people. Methods. The study included 98 patients diagnosed with peripheral arterial disease with IC. The patients traveled a distance of 6 m at a voluntary gait velocity. Ground reaction forces while the foot contacted the ground and kinematic variables of lower limb movements were recorded. The values of normal gait variables were computed based on the results obtained in a group of 30 healthy people. Results. Patients used a gait velocity below the norm for healthy people. The velocity during the lower limb swing and the step and stride length in patients with IC were below the norm. Differences were also found in the ranges of motion between patients with IC and healthy people for the pelvic obliquity, pelvic rotation, hip flexion-extension, hip abduction-adduction, hip internal-external rotation, knee flexion-extension, ankle dorsi-plantar flexion, and foot progression angles. Conclusions. The presented kinematic and kinetic characteristics measured by gait variables suggest differences between patients with IC and healthy people. Considering kinematic and kinetic gait variables during the rehabilitation process would facilitate the development of a more economic gait technique (with increased stride length and range of motion in the lower limb joints) to obtain the desired rehabilitation effects. Patients with IC should receive rehabilitation oriented towards improving mobility and increasing muscle strength in selected lower limb joints to increase gait velocity and stride length.

scholarly journals The efficacy of a motorized lower-limb prosthetic device: a pilot study

2020 ◽  
Author(s):  
Jo Ghillebert ◽  
Joost Geeroms ◽  
Louis Flynn ◽  
Sander De Bock ◽  
Renée Govaerts ◽  
...  
Keyword(s):  
Stride Length ◽  
Metabolic Cost ◽  
Functional Independence ◽  
Stair Climbing ◽  
Daily Activities ◽  
The Novel ◽  
Transfemoral Amputation ◽  
Active Device ◽  
Cost Of Transport ◽  
Experimental Trial

Abstract BACKGROUND Performing daily activities is challenging for individuals with a transfemoral amputation. Technological advancements in prosthetic prototypes aim at improving functional independence. A state-of-the-art active device, the CYBERLEGs-gamma (CLs-ɣ) prosthesis, consisting of powered ankle and knee joints, has been designed and constructed. The control system combines pressure-sensitive insoles and inertial motor units to synchronize both joints to work together. To date, the novel device has not een clinically evaluated. Therefore, the objective of this study was to investigate the efficacy of the CLs-ɣ prosthesis during daily activities compared to current passive and quasi-passive devices . METHODS Participants performed a familiarization trial, an experimental trial with the current prosthesis, three adaptation trials and an experimental trial with the CLs-ɣ prosthesis. Participants completed a stair climbing test, a timed-up & go test, a sit to stand test, a two-minute dual task (i.e. the psychomotor vigilance task during treadmill walking) and a six-minute treadmill walk test at normal speed. Nonparametric Wilcoxon-signed rank tests were conducted with critical alpha set at 0.05. RESULTS Eight individuals with a transfemoral amputation (age: 55 ± 15 years, K-level 3) were included. Stride length significantly increased during walking with the CLs-ɣ prosthesis (p=0.012) because of a greater step length of the amputated leg (p=0.035). Normal walking speed was significantly slower (p=0.018), the net metabolic cost of transport was significantly higher (p=0.028) and reaction time significantly worsened (p=0.012) when walking with the CLs-ɣ compared to the current prosthesis. When participants took stairs, they adopted a step-over-step strategy with the CLs-ɣ prosthesis in contrast to step-by-step wearing the current prosthesis. CONCLUSION S A higher physical effort and cognitive demand were required during activities wearing the novel motorized prosthesis. Although performance outcome measures did not improve, participants had a greater stride length and better simulated able-bodied stair ambulation.

scholarly journals Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Amol M. Karmarkar ◽  
James E. Graham ◽  
Timothy A. Reistetter ◽  
Amit Kumar ◽  
Jacqueline M. Mix ◽  
...  
Keyword(s):  
Lower Limb ◽  
Secondary Data ◽  
Inpatient Rehabilitation ◽  
Lower Limb Amputation ◽  
Medical Rehabilitation ◽  
Limb Amputation ◽  
Future Research ◽  
Case Mix ◽  
Rehabilitation Outcomes ◽  
Lengths Of Stay

The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N= 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.

scholarly journals Enhancing functional abilities and cognitive integration of the lower limb prosthesis

2019 ◽  
Vol 11 (512) ◽  
pp. eaav8939 ◽  
Author(s):  
Francesco Maria Petrini ◽  
Giacomo Valle ◽  
Marko Bumbasirevic ◽  
Federica Barberi ◽  
Dario Bortolotti ◽  
...  
Keyword(s):  
Lower Limb ◽  
Sensory Feedback ◽  
Cognitive Effort ◽  
Limb Amputation ◽  
Functional Abilities ◽  
Haptic Information ◽  
Lower Limb Prosthesis ◽  
Transfemoral Amputees ◽  
The Brain ◽  
Limb Prosthesis

Lower limb amputation (LLA) destroys the sensory communication between the brain and the external world during standing and walking. Current prostheses do not restore sensory feedback to amputees, who, relying on very limited haptic information from the stump-socket interaction, are forced to deal with serious issues: the risk of falls, decreased mobility, prosthesis being perceived as an external object (low embodiment), and increased cognitive burden. Poor mobility is one of the causes of eventual device abandonment. Restoring sensory feedback from the missing leg of above-knee (transfemoral) amputees and integrating the sensory feedback into the sensorimotor loop would markedly improve the life of patients. In this study, we developed a leg neuroprosthesis, which provided real-time tactile and emulated proprioceptive feedback to three transfemoral amputees through nerve stimulation. The feedback was exploited in active tasks, which proved that our approach promoted improved mobility, fall prevention, and agility. We also showed increased embodiment of the lower limb prosthesis (LLP), through phantom leg displacement perception and questionnaires, and ease of the cognitive effort during a dual-task paradigm, through electroencephalographic recordings. Our results demonstrate that induced sensory feedback can be integrated at supraspinal levels to restore functional abilities of the missing leg. This work paves the way for further investigations about how the brain interprets different artificial feedback strategies and for the development of fully implantable sensory-enhanced leg neuroprostheses, which could drastically ameliorate life quality in people with disability.

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