Model Based Design of a Low Cost and Compliant Low Profile Prosthetic Foot.

This paper describes the design of a simple and low-cost compliant low-profile prosthetic foot based on a cantilevered beam of uniform strength. The prosthetic foot is developed such that the maximum stress experienced by the beam is distributed approximately evenly across the length of the beam. Due to this stress distribution, the prosthetic foot exhibits compliant behavior not achievable through standard design approaches (e.g., designs based on simple cantilevered beams). Additionally, due to its simplicity and use of flat structural members, the foot can be manufactured at low cost. An analytical model of the compliant behavior of the beam is developed that facilitates rapid design changes to vary foot size and stiffness. A characteristic prototype was designed and constructed to be used in both a benchtop quasi-static loading test as well as a dynamic walking test for validation. The model predicted the rotational stiffness of the prototype with 5% error. Furthermore, the prototype foot was tested alongside two commercially available prosthetic feet (a low profile foot and an energy storage and release foot) in level walking experiments with a single study participant. The prototype foot displayed the lowest stiffness of the three feet (6.0, 7.1, and 10.4 Nm/deg for the prototype foot, the commercial low profile foot, and the energy storage and release foot, respectively). This foot design approach and accompanying model may allow for compliant feet to be developed for individuals with long residual limbs.

A passive dorsiflexing ankle prosthesis to increase minimum foot clearance during swing.

The biological ankle dorsiflexes several degrees during swing to provide adequate clearance between the foot and ground, but conventional energy storage and return (ESR) prosthetic feet remain in their neutral position, increasing the risk of toe scuffs and tripping. We present a new prosthetic ankle intended to reduce fall risk by dorsiflexing the ankle joint during swing, thereby increasing the minimum clearance between the foot and ground. Unlike previous approaches to providing swing dorsiflexion such as powered ankles or hydraulic systems with dissipative yielding in stance, our ankle device features a spring-loaded linkage that adopts a neutral angle during stance, allowing ESR, but adopts a dorsiflexed angle during swing. The ankle unit was designed, fabricated, and assessed in level ground walking trials on a unilateral transtibial prosthesis user to experimentally validate its stance and swing phase behaviors. The assessment consisted of three conditions: the ankle in an operational configuration, the ankle in a locked configuration (unable to dorsiflex), and the subject's daily use ESR prosthesis. When the ankle was operational, minimum foot clearance (MFC) increased by 13 mm relative to the locked configuration and 15 mm relative to his daily use prosthesis. Stance phase energy return was not significantly impacted in the operational configuration. The increase in MFC provided by the passive dorsiflexing ankle prosthesis may be sufficient to decrease the rate of falls experienced by prosthesis users in the real world.

Evaluating board certification within international advance pharmacy practice frameworks.

Utilizing board certification to advance practice and promote specializationthrough  formal assessment of pharmacists' knowledge and skills is one way the profession  demonstrates its commitment to improving knowledge and competence as well as  assuring optimal outcomes for patients. Credentialing and privileging in health  care provides an opportunity for selfregulation, peer recognition, and evaluation of  a professional's education, training, experience, and competence. Board of  Pharmacy Specialties currently recognizes more than 51,500 active pharmacist  board certifications in 14 specialties. While oriented primarily to pharmacy practice  in the United States, at least one board-certified pharmacist is located in  more than 50 countries, including Spain. The purpose of this paper is to highlight the intersections of board certification and international advanced  pharmacy practice frameworks.

El uso de las certificaciones para impulsar el perfeccionamiento y la especialización profesional mediante la evaluación formal de los  onocimientos y habilidades de los profesionales de farmacia es una de las maneras en que la profesión farmacéutica demuestra su compromiso con la  mejora del nivel de competencia profesional de los farmacéuticos y la obtención de los mejores resultados clínicos de los pacientes. La certificación y la acreditación en el ámbito sanitario brindan oportunidades de autorregulación, de reconocimiento entre colegas y de evaluación de la educación, formación, experiencia y competencias de los profesionales. El Board of Pharmacy Specialties actualmente reconoce a más de 51.500  armacéuticos con certificaciones activas en 14 especialidades farmacéuticas. Aunque las certificaciones están orientadas principalmente a  profesionales que ejercen en los Estados Unidos, hay al menos un farmacéutico  certificado en más de 50 países, incluido España. El objetivo de  ste artículo es poner de manifiesto el papel de las certificaciones otorgadas por  el Board of Pharmacy Specialties con los mecanismos de especialización  profesional existentes a nivel internacional. sound, defensible process. The  verriding concern of BPS is to ensure that the public receives the level of  harmacy services that will improve a patient's quality of life.  A total of 14  specialties are currently recognized by BPS13,14, including: • Board Certified  Nuclear Pharmacist (BCNP), since 1978. • Board Certified Nutrition Support  Pharmacist (BCNSP), since 1988. • Board Certified Pharmacotherapy Specialist  (BCPS), since 1988. • Board Certified Psychiatric Pharmacist (BCPP), since  1994. • Board Certified Oncology Pharmacist (BCOP), since 1996. • Board  Certified Ambulatory Care Pharmacist (BCACP), since 2009. • Board Certified  Critical Care Pharmacist (BCCCP), since 2013. • Board Certified Pediatric  pharmacy Specialist (BCPPS), since 2013. • Board Certified Geriatric  Pharmacist (BCGP), since 2017. • Board Certified Cardiology Pharmacist  (BCCP), since 2017. • Board Certified Infectious Diseases Pharmacist (BCIDP),  since 2017. • Board Certified Sterile Compounding Pharmacist (BCSCP), since  2018. • Board Certified Transplant Pharmacist (BCTXP), since 2018. • Board  Certified Emergency Medicine Pharmacist (BCEMP), since 2020.

A Semi-Powered Ankle Prosthesis and Unified Controller for Level and Sloped Walking.

This paper describes a semi-powered ankle prosthesis and corresponding unified controller that provides biomimetic behavior for level and sloped walking without requiring identification of ground slope or modulation of control parameters. The controller is based on the observation that healthy individuals maintain an invariant external quasi-stiffness (spring like behavior between the shank and ground) when walking on level and sloped terrain. Emulating an invariant external quasi-stiffness requires an ankle that can vary the set-point (i.e., equilibrium angle) of the ankle stiffness. A semi-powered ankle prosthesis that incorporates a novel constant-volume power-asymmetric actuator was developed to provide this behavior, and the unified controller was implemented on it. The device and unified controller were assessed on three subjects with transtibial amputations while walking on inclines, level ground, and declines. Experimental results suggest that the prosthesis and accompanying controller can provide a consistent external quasi-stiffness similar to healthy subjects across all tested ground slopes.

On the design of power gear trains: Insight regarding number of stages and their respective ratios.

This paper presents a formulation for selecting the stage ratios and number of stages in a multistage transmission with a given desired total transmission ratio in a manner that maximizes efficiency, maximizes acceleration, or minimizes the mass of the transmission. The formulation is used to highlight several implications for gear train design, including the fact that minimizing rotational inertia and mass are competing objectives with respect to optimal selection of stage ratios, and that both rotational inertia and mass can often be minimized by increasing the total number of stages beyond a minimum realizable number. Additionally, a multistage transmission will generally provide maximum acceleration when the stage ratios increase monotonically from the motor to the load. The transmission will have minimum mass when the stage ratios decrease monotonically. The transmission will also provide maximum efficiency when the corresponding stages employ constant stage ratios. This paper aims to use this optimization formulation to elucidate tradeoffs between various common objectives in gear train design (efficiency, acceleration, and mass).

Impact of Powered Knee-Ankle Prosthesis on Low Back Muscle Mechanics in Transfemoral Amputees: A Case Series.

Regular use of prostheses is critical for individuals with lower limb amputations to achieve everyday mobility, maintain physical and physiological health, and achieve a better quality of life. Use of prostheses is influenced by numerous factors, with prosthetic design playing a critical role in facilitating mobility for an amputee. Thus, prostheses design can either promote biomechanically efficient or inefficient gait behavior. In addition to increased energy expenditure, inefficient gait behavior can expose prosthetic user to an increased risk of secondary musculoskeletal injuries and may eventually lead to rejection of the prosthesis. Consequently, researchers have utilized the technological advancements in various fields to improve prosthetic devices and customize them for user specific needs. One evolving technology is powered prosthetic components. Presently, an active area in lower limb prosthetic research is the design of novel controllers and components in order to enable the users of such powered devices to be able to reproduce gait biomechanics that are similar in behavior to a healthy limb. In this case series, we studied the impact of using a powered knee-ankle prostheses (PKA) on two transfemoral amputees who currently use advanced microprocessor controlled knee prostheses (MPK). We utilized outcomes pertaining to kinematics, kinetics, metabolics, and functional activities of daily living to compare the efficacy between the MPK and PKA devices. Our results suggests that the PKA allows the participants to walk with gait kinematics similar to normal gait patterns observed in a healthy limb. Additionally, it was observed that use of the PKA reduced the level of asymmetry in terms of mechanical loading and muscle activation, specifically in the low back spinae regions and lower extremity muscles. Further, the PKA allowed the participants to achieve a greater range of cadence than their predicate MPK, thus allowing them to safely ambulate in variable environments and dynamically control speed changes. Based on the results of this case series, it appears that there is considerable potential for powered prosthetic components to provide safe and efficient gait for individuals with above the knee amputation.

Análisis de la certificación en el marco de especialización farmacéutica a nivel internacional / Evaluating board certification within international advance pharmacy practice frameworks

El uso de las certificaciones para impulsar el perfeccionamiento y laespecialización profesional mediante la evaluación formal de los conocimientosy habilidades de los profesionales de farmacia es una de lasmaneras en que la profesión farmacéutica demuestra su compromiso conla mejora del nivel de competencia profesional de los farmacéuticos y laobtención de los mejores resultados clínicos de los pacientes. La certificacióny la acreditación en el ámbito sanitario brindan oportunidades deautorregulación, de reconocimiento entre colegas y de evaluación de laeducación, formación, experiencia y competencias de los profesionales. ElBoard of Pharmacy Specialties actualmente reconoce a más de 51.500 farmacéuticoscon certificaciones activas en 14 especialidades farmacéuticas.Aunque las certificaciones están orientadas principalmente a profesionalesque ejercen en los Estados Unidos, hay al menos un farmacéutico certificadoen más de 50 países, incluido España. El objetivo de este artículo esponer de manifiesto el papel de las certificaciones otorgadas por el Boardof Pharmacy Specialties con los mecanismos de especialización profesionalexistentes a nivel internacional.

Utilizing board certification to advance practice and promote specializationthrough formal assessment of pharmacists’ knowledge and skills is oneway the profession demonstrates its commitment to improving knowledgeand competence as well as assuring optimal outcomes for patients. Credentialingand privileging in health care provides an opportunity for selfregulation,peer recognition, and evaluation of a professional’s education,training, experience, and competence. Board of Pharmacy Specialtiescurrently recognizes more than 51,500 active pharmacist board certificationsin 14 specialties. While oriented primarily to pharmacy practice in theUnited States, at least one board-certified pharmacist is located in morethan 50 countries, including Spain. The purpose of this paper is to highlightthe intersections of board certification and international advanced pharmacypractice frameworks.

Design of a power-asymmetric actuator for a transtibial prosthesis.

This paper presents the design and characterization of a power-asymmetric actuator for a transtibial prosthesis. The device is designed to provide the combination of: 1) joint locking, 2) high power dissipation, and 3) low power generation. This actuator functionality allows for a prosthesis to be designed with minimal mass and power consumption relative to a fully-powered robotic prosthesis while maintaining much of the functionality necessary for activities of daily living. The actuator achieves these design characteristics while maintaining a small form factor by leveraging a combination of electromechanical and hydraulic components. The design of the actuator is described herein, and results of an experimental characterization are provided that indicate that the actuator is capable of providing the functional capabilities required of an ankle prosthesis in a compact and lightweight package.

Variable Cadence Walking and Ground Adaptive Standing With a Powered Ankle Prosthesis.

This paper describes a control approach that provides walking and standing functionality for a powered ankle prosthesis, and demonstrates the efficacy of the approach in experiments with a unilateral transtibial amputee subject. Both controllers incorporate a finite-state structure that emulates healthy ankle joint behavior via a series of piecewise passive impedance functions. The walking controller additionally modifies impedance parameters based on estimated cadence, while the standing controller modulates the ankle equilibrium angle in order to adapt to the ground slope and user posture, and the supervisory controller selects between the walking and standing controllers. The system is shown to reproduce several essential biomechanical features of the healthy joint during walking, particularly relative to a passive prosthesis, and is shown to adapt to various cadences. The system is also shown to adapt to slopes over a range of ±15°, providing support to the user, as validated by quasi-static stiffness measurements recorded by the prosthesis. The subject is shown to place more weight on the powered prosthesis than on his passive prosthesis when standing on sloped surfaces, particularly at angles of 10° or greater. The authors also demonstrated that the prosthesis typically began providing support within 1 s of initial ground contact. Further, the supervisory controller was shown to effectively switch between walking and standing, as well as determine ground slope just prior to the transition from the standing controller to the walking controller, where the estimated ground slope was accurate to within 1.25° for all trials.

Running with a powered knee and ankle prosthesis.

This paper presents a running control architecture for a powered knee and ankle prosthesis that enables a transfemoral amputee to run with a biomechanically appropriate running gait and to intentionally transition between a walking and running gait. The control architecture consists firstly of a coordination level controller, which provides gait biomechanics representative of healthy running, and secondly of a gait selection controller that enables the user to intentionally transition between a running and walking gait. The running control architecture was implemented on a transfemoral prosthesis with powered knee and ankle joints, and the efficacy of the controller was assessed in a series of running trials with a transfemoral amputee subject. Specifically, treadmill trials were conducted to assess the extent to which the coordination controller provided a biomechanically appropriate running gait. Separate trials were conducted to assess the ability of the user to consistently and reliably transition between walking and running gaits.

Walking on uneven terrain with a powered ankle prosthesis: A preliminary assessment.

A successful walking gait with a powered prosthesis depends heavily on proper timing of power delivery, or push-off. This paper describes a control approach which provides improved walking on uneven terrain relative to previous work intended for use on even (level) terrain. This approach is motivated by an initial healthy subject study which demonstrated less variation in sagittal plane shank angle than sagittal plane ankle angle when walking on uneven terrain relative to even terrain. The latter therefore replaces the former as the control signal used to initiate push-off in the powered prosthesis described herein. The authors demonstrate improvement in consistency for several gait characteristics, relative to healthy, as well as controller characteristics with the new control approach, including a 50% improvement in the consistency of the percentage of stride at which push-off is initiated.

A powered prosthetic intervention for bilateral transfemoral amputees.

This paper presents the design and validation of a control system for a pair of powered knee and ankle prostheses to be used as a prosthetic intervention for bilateral transfemoral amputees. The control system leverages communication between the prostheses for enhanced awareness and stability, along with power generation at the knee and ankle joints to better restore biomechanical functionality in level ground walking. The control methodology employed is a combination of an impedance-based framework for weight-bearing portions of gait and a trajectory-based approach for the nonweight-bearing portions. The control system was implemented on a pair of self-contained powered knee and ankle prostheses, and the ability of the prostheses and control approach to provide walking functionality was assessed in a set of experimental trials with a bilateral transfemoral amputee subject. Specifically, experimental data from these trials indicate that the powered prostheses and bilateral control architecture provide gait kinematics that reproduce healthy gait kinematics to a greater extent than the subject's daily-use passive prostheses.

A walking controller for a powered ankle prosthesis.

This paper describes a walking controller implemented on a powered ankle prosthesis prototype and assessed by a below-knee amputee subject on a treadmill at three speeds. The walking controller is a finite state machine which emulates a series of passive impedance functions at the joint in order to reproduce the behavior of a healthy joint. The assessments performed demonstrate the ability of the powered prosthesis prototype and walking controller to reproduce essential biomechanical aspects (i.e. joint angle, torque, and power profiles) of the healthy joint, especially relative to a passive prosthesis.

Realizing the promise of robotic leg prostheses.

Recent advances in robotics technology are enabling the emergence of robotic leg prostheses that can emulate the full biomechanical functionality of the healthy limb. The behavior of such prostheses is software-controllable, in an analogous manner to the way in which the central nervous system controls the human musculoskeletal system. Although these prostheses have the capability of reproducing the biomechanical behavior of the healthy limb, their ability to do so is a function of how well the prosthesis control system coordinates the movement of the leg with the movement of the user.

A preliminary investigation of powered prostheses for improved walking biomechanics in bilateral transfemoral amputees.

The authors conducted a preliminary investigation of the extent to which a pair of powered prostheses can provide improved gait biomechanics in bilateral transfemoral amputee walking. Specifically, a finite state-based impedance controller for level ground walking was implemented in a pair of powered knee and ankle prostheses. The efficacy of the powered prostheses and impedance-based controllers was tested on a healthy subject using able-body adapters. Motion capture data was collected while the subject performed treadmill walking with the powered prostheses. This kinematic data is compared to that of healthy subjects, and also to previously published data for bilateral transfemoral amputee gait with passive prostheses. The comparison indicates that the powered prostheses are able to provide a walking gait that is considerably more representative of healthy biomechanical gait relative to passive prostheses.

A running controller for a powered transfemoral prosthesis.

This paper describes a running controller for a powered knee and ankle prosthesis. The running controller was implemented on a powered prosthesis prototype and evaluated by a transfemoral amputee subject running on a treadmill at a speed of 2.25 m/s (5.0 mph). The ability of the prosthesis and controller to provide the salient features of a running gait was assessed by comparing the kinematics of running provided by the powered prosthesis to the averaged kinematics of five healthy subjects running at the same speed. This comparison indicates that the powered prosthesis and running controller are able to provide essential features of a healthy running gait.

Ground adaptive standing controller for a powered transfemoral prosthesis.

The scope of this work is the design and verification of a new standing controller for a powered knee and ankle prosthesis. The controller is based upon a finite-state impedance control approach previously developed by the authors. The controller provides a comprehensive standing behavior that incorporates ground adaptation for unlevel terrain. An amputee subject tested the controller with a powered prosthesis for a variety of standing conditions. Results indicate that the powered prosthesis can estimate the ground slope within ±1 degree over a range of ±15 degrees, and that it can provide appropriate joint impedances for standing on slopes within this range.

Stumble detection and classification for an intelligent transfemoral prosthesis.

This paper describes an approach for the real-time detection of stumble for use in an intelligent lower limb prosthesis, using accelerometers mounted on the prosthesis, and also describes an algorithm that classifies the stumble response as either an elevating or lowering type response. In order to validate the proposed approach, the investigators collected stumble data on 10 healthy subjects using accelerometers affixed to the subjects in a manner consistent with similar instrumentation on a transfemoral prosthesis. The proposed algorithms were shown to correctly identify stumbling and correctly classify the stumble response for all 19 stumbles and 34 control strides collected in the experiments.