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1.
J Electromyogr Kinesiol ; 55: 102462, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33091790

RESUMO

People with unilateral transtibial amputation (TTA) have biomechanical differences between the amputated and intact legs and compared to people without TTA during running. Additional biomechanical differences emerge between running with running-specific (RSPs) and daily-use prostheses (DUPs), but the associated underlying muscle activity is unclear. We collected surface electromyography from the biceps femoris long head, rectus femoris, vastus lateralis, and gastrocnemius as well as body kinematics and ground reaction forces in six people with and six people without TTA. We compared stance phase muscle activity and peak activation timing in people with and without TTA and between people using RSPs compared to DUPs during running at 3.5 m/s. Peak amputated leg hamstring activity occurred 34% (RSP) and 31% (DUP) earlier in stance phase compared to the intact leg. Peak amputated leg rectus femoris activity of people wearing DUPs occurred 8% and 9% later in stance phase than the intact leg of people wearing DUPs and amputated leg of people wearing RSPs, respectively. People with TTA had 45% (DUP) and 61% (RSP) smaller peak amputated leg knee extension moments compared to people without TTA, consistent with observations of quadriceps muscle activity. Using RSPs decreased overall muscle activity compared to DUPs.


Assuntos
Amputação Cirúrgica/reabilitação , Membros Artificiais/normas , Perna (Membro)/fisiologia , Músculo Esquelético/fisiologia , Corrida/fisiologia , Adulto , Amputados/reabilitação , Fenômenos Biomecânicos/fisiologia , Eletromiografia/métodos , Feminino , Humanos , Masculino
2.
PLoS One ; 15(8): e0237179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760149

RESUMO

Percutaneous osseointegrated (OI) implants are increasingly viable as an alternative to socket suspension of prosthetic limbs. Upper extremity prostheses have also become more complex to better replicate hand and arm function and attempt to recreate pre-amputation functional levels. With more functionality comes heavier devices that put more stress on the bone-implant interface, which could be an issue for implant stability. This study quantified transhumeral loading at defined amputation levels using four simulated prosthetic limb-types: (1) body powered hook, (2) myoelectric hook, (3) myoelectric hand, and (4) advanced prosthetic limb. Computational models were constructed to replicate the weight distribution of each prosthesis type, then applied to motion capture data collected during Advanced Activities of Daily Living (AADLs). For activities that did not include a handheld weight, the body powered prosthesis bending moments were 13-33% (range of means for each activity across amputation levels) of the intact arm moments (reference 100%), torsional moments were 12-15%, and axial pullout forces were 30-40% of the intact case (p≤0.001). The myoelectric hook and hand bending moments were 60-99%, torsional moments were 44-97%, and axial pullout forces were 62-101% of the intact case. The advanced prosthesis bending moments were 177-201%, torsional moments were 164-326%, and axial pullout forces were 133-185% of the intact case (p≤0.001). The addition of a handheld weight for briefcase carry and jug lift activities reduced the overall impact of the prosthetic model itself, where the body powered forces and moments were much closer to those of the intact model, and more complex prostheses further increased forces and moments beyond the intact arm levels. These results reveal a ranked order in loading magnitude according to complexity of the prosthetic device, and highlight the importance of considering the patient's desired terminal device when planning post-operative percutaneous OI rehabilitation and training.


Assuntos
Membros Artificiais/normas , Osseointegração , Torção Mecânica , Suporte de Carga , Membros Artificiais/efeitos adversos , Membros Artificiais/classificação , Fenômenos Biomecânicos , Interface Osso-Implante/fisiologia , Interface Osso-Implante/fisiopatologia , Humanos , Úmero/fisiologia , Úmero/fisiopatologia
3.
Gait Posture ; 81: 41-48, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32663775

RESUMO

BACKGROUND: Minimum Toe Clearance (MTC) is defined as the minimum vertical distance between the lowest point under the front part of the foot and the ground, during mid-swing. Low values of MTC and walking on inclines are both related to higher probability of tripping and falling in lower limb amputees. New prosthetic designs aim at improving MTC, especially on ramps, however the real effect on MTC still needs investigation. The objective of this study was then to evaluate the effect of different prosthetic designs on MTC in inclined walking. METHODS: Thirteen transtibial amputees walked on a ramp using three different prostheses: non articulating ankle (NAA), articulating hydraulic ankle (AHA), and articulating hydraulic ankle with microprocessor (AHA-MP). Median MTC, coefficient of variation (CV), and tripping probability (TP) for obstacles of 10 and 15 mm were compared across ankle type in ascent and descent. FINDINGS: When using AHA-MP, larger MTC median values for ascending (P ≤ 0.001, W = 0.58) and descending the ramp (P = 0.003, W = 0.47) were found in the prosthetic limb. Also significantly lower CV was found on the prosthetic limb for both types of AHA feet when compared to NAA for descending the ramp (P = 0.014, W = 0.45). AHA-MP showed the lowest TP for the prosthetic leg in three conditions evaluated. On the sound limb results showed the median MTC was significantly larger (P = 0.009, W = 0.43) and CV significantly lower (P = 0.005, W = 0.41) when using an AHA in ascent. INTERPRETATION: Both AHA prosthetic designs help reduce the risk of tripping of the prosthetic limb by increasing the median MTC, lowering its variability and reducing TP for both legs when ascending and descending the ramp. For most of the conditions, AHA-MP showed the lowest TP values. Findings suggest that AHA prostheses, especially AHA-MP could reduce the risk of tripping on ramps in amputees.


Assuntos
Amputação Cirúrgica/efeitos adversos , Membros Artificiais/normas , Fenômenos Biomecânicos/fisiologia , Marcha/fisiologia , Desenho de Prótese/normas , Tíbia/cirurgia , Dedos do Pé/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Caminhada
4.
Sci Rep ; 10(1): 10216, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32576891

RESUMO

The contribution of somatosensation to locomotor deficits in below-knee amputees (BKAs) has not been fully explored. Unilateral disruption of plantar sensation causes able-bodied individuals to adopt locomotor characteristics that resemble those of unilateral BKAs, suggesting that restoring somatosensation may improve locomotion for amputees. In prior studies, we demonstrated that electrically stimulating the residual nerves of amputees elicited somatosensory percepts that were felt as occurring in the missing foot. Subsequently, we developed a sensory neuroprosthesis that modulated stimulation-evoked sensation in response to interactions between the prosthesis and the environment. To characterize the impact of the sensory neuroprosthesis on locomotion, we created a novel ambulatory searching task. The task involved walking on a horizontal ladder while blindfolded, which engaged plantar sensation while minimizing visual compensation. We first compared the performance of six BKAs to 14 able-bodied controls. Able-bodied individuals demonstrated higher foot placement accuracy than BKAs, indicating that the ladder test was sensitive enough to detect locomotor deficits. When three of the original six BKAs used the sensory neuroprosthesis, the tradeoff between speed and accuracy significantly improved for two of them. This study advanced our understanding of how cutaneous plantar sensation can be used to acquire action-related information during challenging locomotor tasks.


Assuntos
Assistência Ambulatorial/métodos , Amputados/reabilitação , Membros Artificiais/normas , Retroalimentação Sensorial/fisiologia , Marcha/fisiologia , Córtex Somatossensorial/fisiologia , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Extremidade Inferior , Masculino
5.
J Pediatr Orthop ; 40(6): e532-e536, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501929

RESUMO

BACKGROUND: Syme amputation (SA) is a term used to describe an amputation at the level of the ankle joint in which the heel pad is preserved. It is performed for a number of indications in a pediatric population. SA is purported to hold the advantage of allowing weight bearing without a prosthesis. A limb length discrepancy (LLD) is useful for ambulation without a prosthesis but can be restrictive with regards to the fitting of modern prostheses. METHODS: A voluntary survey was distributed to persons living with SA. Recruitment occurred through hospital electronic database and electronic advertising. Data collected included baseline demographic information, data pertaining to weight bearing in different environments, as well as 2 validated outcome measures: the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R activity restriction scale) and the Locomotor Capabilities Index-5 (LCI-5). An illustration was designed to allow participants to classify their LLD by zone in relation to their nonamputated limb. RESULTS: At total of 47 persons living with SA participated. The average age at amputation was 3.7 years (range, 0.5 to 14.1 y), and at survey completion 15.8 years (1.7 to 60.3). Five of the described "zones" of LLD were represented. Average LCI-5 score was 52.6. Mean TAPES-R activity restriction scale was 0.59, the lowest mean being achieved by zone E participants, indicating the least restriction. Ability to walk without a prosthesis was lower in those participants over 11 years, when compared with those under, as well as being dependent on the walking environment. CONCLUSIONS: Our study found no trend indicating that a very low LLD was functionally optimal, and indeed found participants with a moderate LLD (zone E) to have the least mean restriction with regard to their prosthesis. Our study demonstrates that ambulation without a prosthesis depends on the environment (ie, flooring), and rates decrease significantly into adulthood. Optimal care should not focus simply "preserving length," but rather functional optimization and length modulation in parallel with a nuanced understanding of actual daily activities and prosthetic options. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Amputação Cirúrgica/métodos , Articulação do Tornozelo/cirurgia , Membros Artificiais , Adolescente , Membros Artificiais/efeitos adversos , Membros Artificiais/psicologia , Membros Artificiais/normas , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Satisfação Pessoal , Desempenho Físico Funcional , Estudos Retrospectivos , Inquéritos e Questionários , Caminhada
6.
PLoS One ; 15(4): e0231401, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275734

RESUMO

The traditional treatment protocol for young children with congenital or acquired amputations at or proximal to the knee prescribes a prosthesis without a working knee joint, based in part on the assumption that a child learning to walk cannot properly utilize a passively flexing prosthetic knee component. An alternative to this Traditional Knee (TK) protocol is an "Early Knee" (EK) protocol, which prescribes an articulating prosthetic knee in the child's first prosthesis, during development of crawling and transitioning into and out of upright positions. To date, no study has compared samples of children with limb loss at or proximal to the knee using TK and EK protocols. The purpose of this multi-site study was to examine kinematic outcomes during walking in separate groups of young children in an EK and a TK prosthesis protocol, along with a population of children without lower limb amputations. Eighteen children aged 12 months to five years were recruited for this study at two clinical sites, six in each of the three groups. Children in the two prosthesis groups had unilateral limb loss and had been treated either at one site with the TK protocol or at another with the EK protocol. Children in the EK group achieved swing phase prosthetic knee flexion averaging 59.8±8.4 degrees. Children wearing prosthetic limbs walked slower than age-matched peers. In most instances, walking speed and step length increased with age in the EK group, similar to the control group. However, this trend was not observed in the TK group. Clearance adaptations were present in both limb loss groups. Observed adaptations were twice as prevalent in the TK group versus the EK group; however, the groups differed in age and etiology. Children with limb loss provided with an articulating knee component in their first prosthesis incorporated knee flexion during swing phase and showed fewer gait adaptations than children in the TK protocol.


Assuntos
Amputados/reabilitação , Membros Artificiais/efeitos adversos , Joelho/fisiopatologia , Caminhada , Membros Artificiais/normas , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Humanos , Masculino
7.
Disabil Rehabil ; 42(1): 63-70, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30182755

RESUMO

Purpose: To gather ideas from lower-limb prosthesis users and certified prosthetists regarding possible residual limb monitoring system features and data presentation. We also gathered information on the type of residual limb problems typically encountered, how they currently manage those problems, and their ideas for methods to better manage them.Materials and methods: Two focus groups were held; one with certified prosthetists and another with lower-limb prosthesis users. Open-ended questions were used in a moderated discussion that was audio recorded, transcribed, and assessed using applied thematic analysis.Results and conclusions: Seven individuals participated in each focus group. Prosthetists came from a mix of practice settings, while prosthesis users were diverse in level of amputation, aetiology, and years of experience using lower-limb prostheses. Residual limb problems reported by participants were consistent with those in the literature. Participants suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology. Participants favoured short-term use of a possible residual limb monitoring systems to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements. Participants described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighed inconveniences or concerns regarding system use. A potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.Implications for RehabilitationStakeholders suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology.Stakeholders favored short-term use of a possible system to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements.Stakeholders described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighs any inconveniences or concerns regarding system use.Stakeholders indicated that a potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.


Assuntos
Cotos de Amputação/fisiopatologia , Amputação Cirúrgica , Extremidade Inferior/cirurgia , Monitorização Fisiológica/métodos , Complicações Pós-Operatórias , Adulto , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/métodos , Amputação Cirúrgica/reabilitação , Membros Artificiais/efeitos adversos , Membros Artificiais/normas , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/reabilitação , Desenho de Prótese/métodos , Desenho de Prótese/normas , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos
8.
J Electromyogr Kinesiol ; 48: 152-160, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31357113

RESUMO

Research in pattern recognition (PR) for myoelectric control of the upper limb prostheses has been extensive. However, there has been limited attention to the factors that influence the clinical translation of this technology. A relevant factor of influence in clinical performance of EMG PR-based control of prostheses is the variation in muscle activation level, which modifies the EMG patterns even when the amputee attempts the same movement. To decrease the effect of muscle activation level variations on EMG PR, this work proposes to use dynamic time warping (DTW) and is validated on two databases. The first database, which has data from ten intact-limbed subjects, was used to test the baseline performance of DTW, resulting in an average classification accuracy of more than 90%. The second database comprised data from nine upper limb amputees recorded at three levels of force for six hand grips. The results showed that DTW trained at a single force level achieved an average classification accuracy of 60 ±â€¯9%, 70 ±â€¯8%, and 60 ±â€¯7% at the low, medium and high force levels respectively across all amputee subjects. The proposed scheme with DTW achieved a significant 10% improvement in classification accuracy when trained at a low force level when compared to the traditional time-dependent power spectrum descriptors (TD-PSD) method.


Assuntos
Membros Artificiais/normas , Eletromiografia/métodos , Mãos/fisiologia , Reconhecimento Automatizado de Padrão/métodos , Adulto , Eletromiografia/normas , Mãos/fisiopatologia , Humanos , Masculino , Movimento , Músculo Esquelético/fisiologia , Músculo Esquelético/fisiopatologia , Reconhecimento Automatizado de Padrão/normas
9.
J Rehabil Med ; 51(3): 209-216, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30815704

RESUMO

OBJECTIVE: Currently available hand prostheses lack sensory feedback. A "phantom hand map", a referred sensation, on the skin of the residual arm is a possible target to provide amputees with non-invasive somatotopically matched sensory feedback. How-ever, not all amputees experience a phantom hand map. The aim of this study was to explore whether touch on predefined areas on the forearm can be associated with specific fingers. DESIGN: A longitudinal cohort study. SUBJECTS: A total of 31 able-bodied individuals. METHODS: A "tactile display" was developed consisting of 5 servo motors, which provided the user with mechanotactile stimulus. Predefined pressure points on the volar aspect of the forearm were stimulated during a 2-week structured training period. RESULTS: Agreement between the stimulated areas and the subjects' ability to discriminate the stimulation was high, with a distinct improvement up to the third training occasion, after which the kappa score stabilized for the rest of the period. CONCLUSION: It is possible to associate touch on intact skin on the forearm with specific fingers after a structured training period, and the effect persisted after 2 weeks. These results may be of importance for the development of non-invasive sensory feedback systems in hand prostheses.


Assuntos
Membros Artificiais/normas , Retroalimentação Sensorial/fisiologia , Antebraço/fisiologia , Tato/fisiologia , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
J Vis Exp ; (143)2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30663709

RESUMO

This work describes a methodological framework that can be used to explicitly and implicitly characterize the sense of agency developed over the neural-machine interface (NMI) control of sensate virtual or robotic prosthetic hands. The formation of agency is fundamental in distinguishing the actions that we perform with our limbs as being our own. By striving to incorporate advanced upper-limb prostheses into these same perceptual mechanisms, we can begin to integrate an artificial limb more closely into the user's existing cognitive framework for limb control. This has important implications in promoting user acceptance, use, and effective control of advanced upper-limb prostheses. In this protocol, participants control a virtual prosthetic hand and receive kinesthetic sensory feedback through their preexisting NMIs. A series of virtual grasping tasks are performed and perturbations are systematically introduced to the kinesthetic feedback and virtual hand movements. Two separate measures of agency are employed: established psychophysical questionnaires (to capture the explicit experience of agency) and a time interval estimate task to capture the implicit sense of agency (intentional binding). Results of this protocol (questionnaire scores and time interval estimates) can be analyzed to quantify the extent of agency formation.


Assuntos
Membros Artificiais/normas , Retroalimentação Sensorial/fisiologia , Desempenho Psicomotor/fisiologia , Adulto , Feminino , Humanos , Masculino
11.
J Am Assoc Nurse Pract ; 31(6): 337-343, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-30681650

RESUMO

BACKGROUND AND PURPOSE: Prosthetic joint infection (PJI) is a serious complication resulting from total knee arthroplasty (TKA) or total hip arthroplasty (THA). In this study, patients with a PJI are compared with patients with an uncomplicated postoperative course to identify relevant risk factors for PJI. METHODS: A matched case-control study was performed with patients undergoing fast-track, elective unilateral TKA or THA. The following data were collected: demographics, surgery-related characteristics (perioperative blood loss, use of cement, body temperature), and postoperative characteristics (hematoma formation, wound leakage, blood transfusion, length of stay [LOS]). CONCLUSIONS: When the PJI group was compared with the control group, there was significantly more wound leakage during hospital stay (88% vs. 36%, p = .001) and early wound dressing changes in the first 3 days after surgery (88% vs. 40%, p = .002). Hematoma formation was observed more in the PJI patients group (44% vs. 10%, p = .005). A trend test revealed a significant association between the total number of wound dressing changes and development of PJI (p < .001); 72% of PJI patients had a length of stay of ≥4 days compared with 34% of controls (odds ratio 10.5; 95% CI [2.1-52.3]; p = .004). IMPLICATIONS FOR PRACTICE: Early postoperative wound drainage and hematoma formation directly correlate with PJI. This resulted in a significantly higher number of dressing changes and longer LOS. The nurse practitioner has a central role in postoperative care and is the first to recognize signs of an adverse postoperative clinical course.


Assuntos
Membros Artificiais/normas , Drenagem/efeitos adversos , Infecção dos Ferimentos/diagnóstico , Ferimentos e Lesões/microbiologia , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Membros Artificiais/microbiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Infecção dos Ferimentos/fisiopatologia , Ferimentos e Lesões/fisiopatologia
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 1755-1758, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30440735

RESUMO

Historically, Classic Extended Physiological Proprioception (EPP) as an upper-limb prosthesis control topology has been outperforming functionally all other topologies of the past. A novel Biomechatronic EPP controller has been designed to overcome shortcomings of the classic EPP control topology, and has been hypothesized to be functionally equivalent to the classic EPP topology. Using the dSpace realtime hardware platform and other mechanical and electronic components, the following were developed in the lab: (a) A Biomechatronic EPP controller, (b) a classic EPP controller, (c) an "unconnected" controller and (d) an EMG controller. All four topologies were tested in the lab using the target experiments methodology. Initial results of one subject show that performance of (a) is superior or comparable to (b) and superior to (c) and (d).


Assuntos
Membros Artificiais , Robótica , Membros Artificiais/normas , Tecnologia Biomédica/instrumentação , Tecnologia Biomédica/normas , Humanos , Propriocepção , Robótica/instrumentação , Robótica/normas
13.
J Med Ethics ; 44(10): 661-665, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29903852

RESUMO

Human allografts for life-threatening organ failure have been demonstrated to be lifesaving and are now considered to be standard of care for many conditions. Transplantation of non-vital anatomic body parts has also been accomplished. Hand transplantation after limb loss in adults has been shown to offer some promising benefits in both functional and psychological measures in preliminary studies. It has been suggested to expand eligibility criteria to include minors, with one such operation having already been performed. With this in mind, we examine the current state of hand transplantation research in the context of available alternatives. We examine the ethics of carrying out these operations in minors, including under the protections of clinical research. We argue that children should not be considered for this surgery due to the substantial risks of immunosuppressive medication, the likelihood that the graft will need to be replaced during the patient's lifetime and the lack of significant compensatory advantages over modern prosthetics.


Assuntos
Membros Artificiais , Rejeição de Enxerto/fisiopatologia , Transplante de Mão , Menores de Idade , Seleção de Pacientes/ética , Complicações Pós-Operatórias/fisiopatologia , Fatores Etários , Membros Artificiais/normas , Membros Artificiais/tendências , Criança , Pré-Escolar , Rejeição de Enxerto/imunologia , Transplante de Mão/efeitos adversos , Transplante de Mão/ética , Transplante de Mão/reabilitação , Humanos , Complicações Pós-Operatórias/imunologia , Medição de Risco , Imunologia de Transplantes
14.
US Army Med Dep J ; (2-18): 38-47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30623397

RESUMO

Ischial containment sockets are the current standard of care for military service members with transfemoral amputation. However, they fit intimately with the ischium, which may limit hip motion and contribute to proximal socket discomfort, a common complaint among prosthesis users. Subischial sockets, such as the newly described Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket technique, do not interact with the ischium, potentially increasing hip motion and improving comfort. PURPOSE: To transfer the NU-FlexSIV Socket technique to military prosthetists and evaluate performance among military service members with transfemoral amputation. STUDY DESIGN: case series. METHODS: Four of the 11 enrolled subjects completed the study protocol comparing the NU-FlexSIV Socket to the ischial containment socket. Gait kinematics (over ground and on stairs), physical performance measures (Four-Square Step Test, T-test of Agility, and an obstacle course), limb-socket motion, and socket comfort were assessed after accommodation time in each socket. RESULTS: While wearing the NU-FlexSIV Socket, sagittal plane hip motion generally increased while coronal plane trunk motion and walking speed remained largely unaffected during over ground walking. During stair ascent, sagittal plane hip motion increased while wearing the NU-FlexSIV Socket, with minimal changes in walking speed for all subjects. Pre- and post-walking fluoroscopy measures suggest fit of the NU-FlexSIV Socket was less affected by activity. Most subjects reported that the NU-FlexSIV Socket was more comfortable for sitting but some found it less comfortable for walking and running. Performance measure results were mixed. Although attempts were made to consistently implement the NU-FlexSIV Socket technique, some challenges were experienced. CONCLUSIONS: The NU-FlexSIV Socket provided greater hip motion across a variety of tasks without adversely affecting other movement mechanics but did not consistently improve socket comfort. Variability in the liners and socket materials used may have contributed to variability in results. Overall, the design was a viable alternative to traditional ischial containment sockets for some individuals with transfemoral amputation.


Assuntos
Amputação Cirúrgica/instrumentação , Membros Artificiais/normas , Fêmur/lesões , Adolescente , Adulto , Amputação Cirúrgica/métodos , Amputação Cirúrgica/normas , Desenho de Equipamento/normas , Feminino , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Amplitude de Movimento Articular/fisiologia
15.
Disabil Rehabil Assist Technol ; 13(8): 740-744, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-28844167

RESUMO

OBJECTIVE: The purpose of this study was to examine effects of usage and demographics on damage to the Jaipur Foot prosthesis as well as the epidemiology and etiology of amputations performed at Santokba Durlabjhi Memorial Hospital (SDMH) in Jaipur, India. DESIGN: Total time spent standing, total time spent wearing and total distance walked were compared against severity and location of damage to the prosthesis. Time between initial fitting and follow-up visit for damaged prosthetic was also considered in this analysis. A novel damage severity scale based on prosthesis functionality is presented along with a damage location legend. RESULTS: Patients from 10 different states and two territories throughout India were included in the study. No main effects were found to be statistically significant in predicting severity or location of damage. Only the interaction between a patient's total time spent standing and their total time spent wearing the prosthesis as well as the interaction between a patient's total time spent standing and total distance walked was significant in predicting location of damage to the Jaipur Foot (p = .0327, p = .0278, respectively). CONCLUSIONS: The lack of significant usage factor effect on damage severity or location could support previous findings that lack standardization in materials and manufacturing processes, which is the major drawback of the Jaipur Foot. Implications for Rehabilitation The Jaipur Foot is a safe, reliable and stable product as no abrupt breakage or sudden falls causing injury to the patient were noted. Hence, it is a safe rehabilitation device for lost limbs. The population can squat and sit cross-legged while wearing the prosthetic foot and it does not affect damage severity or location of damage, allowing for these activities to be performed while rehabilitating. The manufacturing of the foot needs to be standardized to improve life of foot. Total time spent standing, total time spent wearing and total distance walked were not predictive of severity or location of damage to the prosthesis, hence providing patient guidelines for activity during rehabilitation.


Assuntos
Amputados/reabilitação , Membros Artificiais/normas , Desenho de Prótese/normas , Falha de Prótese , Feminino , , Humanos , Índia , Masculino , Características de Residência , Fatores Socioeconômicos , Fatores de Tempo , Caminhada
16.
J Pediatr Orthop ; 37 Suppl 2: S22-S25, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28799990

RESUMO

Amputation is not a defeat or failure of treatment, but an effective management strategy for certain conditions in the pediatric population. The principles of management, especially in the pediatric population, have not changed. Current surgical strategies focus on providing an optimal residual limb for prosthetic fitting. New technology provides improvement in the design and fabrication of prosthetic devices.


Assuntos
Amputação Cirúrgica/métodos , Membros Artificiais/normas , Desenho de Prótese/normas , Criança , Humanos , Qualidade de Vida
17.
Rev Neurosci ; 28(8): 913-920, 2017 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-28850551

RESUMO

Studies have shown that patients who practice functional movements at home in conjunction with outpatient therapy show higher improvement in motor recovery. However, patients are not qualified to monitor or assess their own condition that must be reported back to the clinician. Therefore, there is a need to transmit physiological data to clinicians from patients in their home environment. This paper presents a review of wearable technology for in-home health monitoring, assessment, and rehabilitation of patients with brain and spinal cord injuries.


Assuntos
Lesões Encefálicas/reabilitação , Paralisia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Dispositivos Eletrônicos Vestíveis/normas , Membros Artificiais/classificação , Membros Artificiais/normas , Humanos , Dispositivos Eletrônicos Vestíveis/classificação
18.
J Appl Physiol (1985) ; 123(1): 38-48, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28360121

RESUMO

Running-specific prostheses enable athletes with lower limb amputations to run by emulating the spring-like function of biological legs. Current prosthetic stiffness and height recommendations aim to mitigate kinematic asymmetries for athletes with unilateral transtibial amputations. However, it is unclear how different prosthetic configurations influence the biomechanics and metabolic cost of running. Consequently, we investigated how prosthetic model, stiffness, and height affect the biomechanics and metabolic cost of running. Ten athletes with unilateral transtibial amputations each performed 15 running trials at 2.5 or 3.0 m/s while we measured ground reaction forces and metabolic rates. Athletes ran using three different prosthetic models with five different stiffness category and height combinations per model. Use of an Ottobock 1E90 Sprinter prosthesis reduced metabolic cost by 4.3 and 3.4% compared with use of Freedom Innovations Catapult [fixed effect (ß) = -0.177; P < 0.001] and Össur Flex-Run (ß = -0.139; P = 0.002) prostheses, respectively. Neither prosthetic stiffness (P ≥ 0.180) nor height (P = 0.062) affected the metabolic cost of running. The metabolic cost of running was related to lower peak (ß = 0.649; P = 0.001) and stance average (ß = 0.772; P = 0.018) vertical ground reaction forces, prolonged ground contact times (ß = -4.349; P = 0.012), and decreased leg stiffness (ß = 0.071; P < 0.001) averaged from both legs. Metabolic cost was reduced with more symmetric peak vertical ground reaction forces (ß = 0.007; P = 0.003) but was unrelated to stride kinematic symmetry (P ≥ 0.636). Therefore, prosthetic recommendations based on symmetric stride kinematics do not necessarily minimize the metabolic cost of running. Instead, an optimal prosthetic model, which improves overall biomechanics, minimizes the metabolic cost of running for athletes with unilateral transtibial amputations.NEW & NOTEWORTHY The metabolic cost of running for athletes with unilateral transtibial amputations depends on prosthetic model and is associated with lower peak and stance average vertical ground reaction forces, longer contact times, and reduced leg stiffness. Metabolic cost is unrelated to prosthetic stiffness, height, and stride kinematic symmetry. Unlike nonamputees who decrease leg stiffness with increased in-series surface stiffness, biological limb stiffness for athletes with unilateral transtibial amputations is positively correlated with increased in-series (prosthetic) stiffness.


Assuntos
Amputação Cirúrgica , Membros Artificiais/normas , Atletas , Desenho de Prótese/normas , Corrida/fisiologia , Tíbia/cirurgia , Adulto , Fenômenos Biomecânicos/fisiologia , Feminino , Humanos , Masculino , Desenho de Prótese/instrumentação
19.
Biomed Tech (Berl) ; 62(4): 447-454, 2017 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-27865091

RESUMO

There are a number of prosthetic terminal devices which offer functional restoration to individuals with upper limb deficiencies. Hosmer and Ottobock are major commercial hook providers for prosthetic terminal devices. The concern of this paper is to analyse the voluntary opening (VO) Ottobock model 10A18 and Hosmer model 99P hooks (one band) during opening operation and to find out favourable features in the design. Two tests were conducted to analyse the performance of both hooks. The first test used a simple bench tool to investigate cable excursion and hook opening angle and the second test used force sensor to find out the force supplied at a different hook opening angle. The study found that the average cable excursion for both hooks is approximately 30% less than the hook's opening span with the force at the hook's tip section being inversely proportional to the force at the lateral section. Ottobock 10A18 has a better control for grasping larger objects, while Hosmer 99P has the highest average force at the tip section but yet less efficient in generating adequate force for activities of daily living. Favourable features identified are low cable excursion per hook opening span and balance lateral to hook tip pinch force.


Assuntos
Membros Artificiais/normas , Força da Mão/fisiologia , Desenho de Prótese , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Humanos
20.
IEEE Trans Haptics ; 9(4): 499-507, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27992321

RESUMO

Efforts are underway to restore sensorimotor function in amputees and tetraplegic patients using anthropomorphic robotic hands. For this approach to be clinically viable, sensory signals from the hand must be relayed back to the patient. To convey tactile feedback necessary for object manipulation, behaviorally relevant information must be extracted in real time from the output of sensors on the prosthesis. In the present study, we recorded the sensor output from a state-of-the-art bionic finger during the presentation of different tactile stimuli, including punctate indentations and scanned textures. Furthermore, the parameters of stimulus delivery (location, speed, direction, indentation depth, and surface texture) were systematically varied. We developed simple decoders to extract behaviorally relevant variables from the sensor output and assessed the degree to which these algorithms could reliably extract these different types of sensory information across different conditions of stimulus delivery. We then compared the performance of the decoders to that of humans in analogous psychophysical experiments. We show that straightforward decoders can extract behaviorally relevant features accurately from the sensor output and most of them outperform humans.


Assuntos
Membros Artificiais/normas , Retroalimentação Sensorial/fisiologia , Dedos/fisiologia , Psicofísica/métodos , Robótica/métodos , Percepção do Tato/fisiologia , Humanos
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