This meta-analysis was performed to increase knowledge and understanding on prosthetics and to research what works better for these amputees. This should be used to inform us as clinicians as to what we need to focus on with our amputee patients and what to not overlook throughout the rehabilitation process.
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Meta-analysis on Prosthetics
1. PROPER EVALUATIONS AND
SUGGESTIONS OF EQUIPMENT FOR
SERVICEMEMBERS WITH LOWER LIMB
AMPUTATIONS ATTEMPTING TO RETURN
TO PHYSICAL ACTIVITES
Toney, CM: Norwich University, Northfield, Vermont
2. Returning to Active Duty
Redeployed or taking on physically demanding occupations
You may be wondering, how is this possible?
According to John Fergason, chief of prosthetics at the Army
Center for the Intrepid at Fort Sam in Houston, Texas,
“When we have someone we know wants to return, their rehab is geared that
way.”
Fergason and his colleague, Ryan Blanck, say that each branch of the military
has its own guidelines for allowing an amputated soldier to return to work,
depending on his or her task. In many cases, it takes at least a year for a
soldier to return to duty. The requirements for a fighter pilot, for instance, will
be different than those for an infantryman or a behind-the-scenes supplies
manager.
But Fergason says that the soldiers who are going back into battle are able to
perform just as well, if not better, than some of their fellow soldiers.
3. Research Focus
Balance ability and its relation to mobility
Factors related to high-level mobility in service members
Effects of gait with prosthetic Ankle Motions
Effects of walking speed and prosthetic ankle adapters on
upper extremity dynamics
Assessment of gait stability in lower-limb amputees
Effect of running speed and leg prostheses on Medio lateral
foot placement
4. Role of balance ability and confidence in prosthetic
use for mobility of people with lower-limb loss
MEASUREMENTS
I. Self-reported prosthetic use for mobility
a. Duration of daily prosthesis wear
b. Use of prosthesis and assistive device
c. Perceived stability when using the prosthesis for mobility on terrains
II. Balance confidence using ABC
a. 16 tasks
III. Performance-based balance ability
a. BBS
b. 14 tasks that challenge static and dynamic balance
RESULTS
5. Factors related to high-level mobility in male service
members with traumatic lower-limb loss
METHODS
I. High-Level Mobility – CHAMP score
a. Single Limb Stance (SLS)
b. Edgren Side Step Test (ESST)
c. T-Test
d. Illinois Agility Test (IAT)
RESULTS
6. The effects of increased prosthetic ankle motions on
the gait of persons with bilateral transtibial
amputations
METHODS
I. 1) Seattle Lightfoot II 2) Seattle Lightfoot II w/ Endolite Multiflex
Ankles/Otto Bock Torsion Adapters 3) Endolite Multiflex Ankles
w/ Otto Bock Torsion Adapters
II. Data Collection and Analyses using eight-camera motion
capture system and embedded flush with the floor used for
ground reaction forces
III. 5-point Likert scale used for subjective perceptions
8. The effects of walking speed on prosthetic ankle adapters on
upper extremity dynamics and stability-related parameters in
bilateral transtibial amputee gait
METHODS
I. Overground walking trials along a ten meter level walkway
II. PC1)Seattle Lightfoot II foot, Multiflex Ankle PC2)Seattle
Lightfoot II, Multiflex Ankle, and Torsion Adapter
III. Digital motion capture system
IV. T-test
RESULTS
9. Assessment of gait stability, harmony, and symmetry in
subjects with lower-limb amputation evaluated by trunk
accelerations
METHODS
I. Before dismissal from hospital subjects performed:
a. 10 m walking test
b. Stood on a line and walked straight for 10 m at a self-selected speed
c. Then arrived at a 15 m long rehabilitation gym
RESULTS
10. Effect of running speed and leg prostheses on
Medio lateral foot placement and its variability
METHODS
I. Measured midline of the body and center of pressure in the ML
direction
II. Running speeds ranged up to maximum on a treadmill
III. Data was compared between non-amputees, UTAs, and BTAs
RESULTS
11. Sprinters running at different
speeds
Non-Amputee
Vs
Unilateral Transtibial Amputee
Vs
Bilateral Transtibial Amputee
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295868/
12. Conclusion
Meta-Analysis was performed to increase knowledge and
understanding on prosthetics and to research what works
better for these amputees. This should be used to inform us
as clinicians as to what we need to focus on with our
amputee patients and what to not overlook throughout the
rehabilitation process.
13. References
Arellano, C., McDermott, W., Kram, R., and Grabowski, A. Effect of running speed and leg prostheses and
mediolateral foot placement and its variability. 2015; 10(1): e0115637. doi:
10.1371/journal.pone.0115637.
Gaunard, I., Roach, K., Raya, M., Hooper, R., Linberg, A., Laferrier, J., et. al. Factors related to high level
mobility in male servicemembers with traumatic lower-limb loss. Journal of Rehabilitation &
Development. 2013; 50(7): 969-984. http://www.rehab.research.va.gov/jour/2013/507/page969.html
Iosa, M., Paradisi, F., Brunelli, S., Delussu, A., Pellegrini, R., Zenardi, D., et. al. Assessment of gait stability,
harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.
Journal of Rehabilitation Research & Development. 2014; 51(4): 623-634.
http://www.rehab.research.va.gov/jour/2014/514/page623.html
Major, M., Stine, R., and Gard, S. The effects of walking speed and prosthetic ankle adapters on upper
extremity dynamics and stability-related parameters in bilateral transtibial amputee gait. 2013;
38(4): 858-863. doi: 10.1016/j.gaitpost.2013.04.012.
Su, P., Gard, S., Lipschutz, R., and Kuiken, T. The effects of increased prosthetic ankle motions on the
gait of persons with bilateral transtibial amputations. Am J Phys Med Rehabil. 2010; 89(1):
34-47. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805409/
Wong, C., Chen, C., Benoy, S., Rahal, R., and Blackwell, W. Role of balance ability and confidence in
prosthetic use for mobility of people with lower-limb loss. Journal of Rehabilitation Research
& Development. 2014; 51(9): 1353-1364. http://www.rehab.research.va.gov/jour/2014/519/JRR
-2013-11-0235.html
New Prosthetics Keep Amputee Soldiers on Active Duty. U.S. News Web site.
http://www.usnews.com/news/articles/2012/05/25/new-prosthetics-keep-amputee-soldiers-on-active
duty
Published May 25, 2012. Accessed April 26, 2015.
Editor's Notes
A little background
There is still a long ways to go for improvements with prosthetics, but they are seeing a bright future for powered prosthetics that will allow soldiers to lift extremely heavy objects with little effort.
ABC = Activities-Specific Balance Confidence scale
II. 16 tasks (ranging from retrieving an object from the floor, at eye level, and above one’s head to walking in a parking lot, up and down ramps, and on icy sidewalks)
RESULTS -This study is a good start to determining whether screening people with these three balance tasks combined with the self-report ABC and the number of comorbidities can facilitate the people with lower-limb loss who have not achieved a level of satisfactory prosthetic use and may need additional care
CHAMP: Comprehensive High-Level Activity Mobility Predictor
RESULTS: Greater high-level mobility was related to lower-limb strength and dynamic balance, smaller waist circumference, use of a J-shaped foot, and greater time spent with ambulation. Was also related to having at least one-intact knee joint and ability to displace the center of mass over the base of support. For service members with bilateral transtibial amputations, a greater high-level mobility was seen with a larger waist circumference. The level of amputation and number of intact knee and ankle joints strongly predict CHAMP performance. This supports the need to preserve the knee joint when possible to maximize the functional potential of service members with lower-limb loss. Having the ability to utilize the knee and hip musculature is significant when performing high-level activities. Rehabilitation interventions should be designed to improve lower-limb and trunk strength, dynamic balance over the prosthesis, and lower-limb trunk flexibility could also improve high-level mobility.
Ambulated at three speeds – freely-selected walking speed, fastest comfortable speed, and slowest comfortable speed
Endolite provides flexion and Otto Bock provides torsion. Seattle Lightfoot II provided shock absorption.
Subjects preferred the combined configuration because they felt like they could walk longer distances and ambulation was smoother and easier to walk on uneven ground. The gait analysis also showed narrower step widths with the combined configuration versus the baseline. Study suggests prosthetic feet that provide increased motions in the sagittal and transverse planes.
Objective: To characterize the upper extremity kinematics of BTAs during steady-state walking.
Three walking speeds (normal, fastest comfortable, slowest comfortable)
T-test: used to compare amputee and able-bodied data
Helen Hayes marker set used for lower extremity and trunk and shoulder abduction
RESULTS: Peak shoulder abduction was greater and lateral trunk flexion was substantially greater than the able-bodies. The study suggests that prosthetic adapters that increase passive ankle ROM can slightly reduce step width which can challenge upright balance especially at faster speeds. It may be beneficial for the safety of the patient if clinicians focus on minimizing the lateral sway.
- This was the first study to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital. Also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.
METHODS: During the testing they wore an elastic belt with a sensor device measuring accelerations along the three body axes.
RESULTS: Accelerations were related more to motor control than biomechanical issues. This study shows that rehabilitators should train subjects to progressively optimize gait features such as stability, efficiency, and functioning by make a safe decision in walking speed. Harmonly should be focused on because it is crucial for optimizing physiological gait.
NOTE: If you watch the video of the male bilateral transtibial amputee running at his fastest speed he’s able to walk without an almost wobble when he holds on, but as soon as he lets go his form completely changes. This is something that really should be focused on for these patients.
RESULTS: Measuring ML foot placement can be helpful in assessing balance problems in runners and sprinters. Results showed that compared to slow speeds, maintaining lateral balance is more challenging at faster running speeds up to maximum sprint speed and sprinter with a unilateral transtibial amputation found maintaining lateral balance just as challenging as non-amputee sprinters. The BTA sprinter exhibited the greatest increase in ML foot placement variability across normalized speed, indicating that maintaining lateral balance was the most challenging for this subject.