Monitoring Functional Capability of Individuals with Lower Limb Amputations Using Mobile Phones

To be effective, a prescribed prosthetic device must match the functional requirements and capabilities of each patient. These capabilities are usually assessed by a clinician and reported by the Medicare K-level designation of mobility. However, it is not clear how the K-level designation objectively relates to the use of prostheses outside of a clinical environment. Here, we quantify participant activity using mobile phones and relate activity measured during real world activity to the assigned K-levels. We observe a correlation between K-level and the proportion of moderate to high activity over the course of a week. This relationship suggests that accelerometry-based technologies such as mobile phones can be used to evaluate real world activity for mobility assessment. Quantifying everyday activity promises to improve assessment of real world prosthesis use, leading to a better matching of prostheses to individuals and enabling better evaluations of future prosthetic devices.Max Nader Center for Rehabilitation Technologies and Outcome

A Rehabilitation Engineering Course for Biomedical Engineers

This paper describes an upper division elective course in rehabilitation engineering that addresses prosthetics and orthotics, wheelchair design, seating and positioning, and automobile modifications for individuals with disabilities. Faculty lectures are enhanced by guest lectures and class field trips. Guest lecturers include a prosthetist and a lower extremity amputee client, an engineer/prosthetist specializing in the upper extremity, and a rehabilitation engineer. The lower extremity prosthetist and his client present a case study for prosthetic prescription, fabrication, fitting, alignment, and evaluation. The engineer/prosthetist contrasts body-powered versus externally powered upper extremity prostheses and associated design, fitting, and functional considerations; he also discusses myoelectric signal conditioning, signal processing, and associated control strategies for upper extremity prosthetic control. Finally, the rehabilitation engineer presents case studies related to assessment and prescription of mobility aids, environmental control systems, and children\u27s toys. The course also includes visits to a local prosthetic and orthotic facility to observe typical fabrication, fitting, and alignment procedures and a driver rehabilitation program for exposure to driver assessment, training, and common vehicle modifications. These applications of biomedical engineering to persons with disabilities have been well received by the students and have furthered interdisciplinary design and research projects

EMG-driven control in lower limb prostheses: a topic-based systematic review

Background The inability of users to directly and intuitively control their state-of-the-art commercial prosthesis contributes to a low device acceptance rate. Since Electromyography (EMG)-based control has the potential to address those inabilities, research has flourished on investigating its incorporation in microprocessor-controlled lower limb prostheses (MLLPs). However, despite the proposed benefits of doing so, there is no clear explanation regarding the absence of a commercial product, in contrast to their upper limb counterparts. Objective and methodologies This manuscript aims to provide a comparative overview of EMG-driven control methods for MLLPs, to identify their prospects and limitations, and to formulate suggestions on future research and development. This is done by systematically reviewing academical studies on EMG MLLPs. In particular, this review is structured by considering four major topics: (1) type of neuro-control, which discusses methods that allow the nervous system to control prosthetic devices through the muscles; (2) type of EMG-driven controllers, which defines the different classes of EMG controllers proposed in the literature; (3) type of neural input and processing, which describes how EMG-driven controllers are implemented; (4) type of performance assessment, which reports the performance of the current state of the art controllers. Results and conclusions The obtained results show that the lack of quantitative and standardized measures hinders the possibility to analytically compare the performances of different EMG-driven controllers. In relation to this issue, the real efficacy of EMG-driven controllers for MLLPs have yet to be validated. Nevertheless, in anticipation of the development of a standardized approach for validating EMG MLLPs, the literature suggests that combining multiple neuro-controller types has the potential to develop a more seamless and reliable EMG-driven control. This solution has the promise to retain the high performance of the currently employed non-EMG-driven controllers for rhythmic activities such as walking, whilst improving the performance of volitional activities such as task switching or non-repetitive movements. Although EMG-driven controllers suffer from many drawbacks, such as high sensitivity to noise, recent progress in invasive neural interfaces for prosthetic control (bionics) will allow to build a more reliable connection between the user and the MLLPs. Therefore, advancements in powered MLLPs with integrated EMG-driven control have the potential to strongly reduce the effects of psychosomatic conditions and musculoskeletal degenerative pathologies that are currently affecting lower limb amputees

Biomechanics of Prosthetic Knee Systems : Role of Dampening and Energy Storage Systems

One significant drawback of the commercial passive and microprocessored prosthetic devices, the inability of delivering positive energy when needed, is due to the absence of the knee flexion during stance phase. Moreover, consequences such as circumduction and disturbed gait pattern take place due to the improper energy flow at the knee and the absence of the positive energy delivery during the swing phase. Current generation powered design has solved these problems by delivering the needed energy with heavy battery demanding motors, which increase the mass of the device significantly. Hence, the gait quality of transfemoral amputees has not improved significantly in the last 50 years due to the inefficient energy flow distribution causing the patient to hike his/her pelvis, which leads to back pain in the long run. In this context, state-of-art prosthetics technology is trending toward creating energy regenerative devices, which are able to harvest/ return energy during ambulation by a spring mechanism, since a spring not only permits significant power demand reduction but also provides high power-to-weight ratio. This study will examine the sagittal plane knee moment versus knee flexion angle properties robotically, clinically and theoretically to explore the functional stiffness of a healthy knee as well as a prosthetic knee during the energy return and harvest phases of gait. With this intention, a prosthetic knee test method will be developed for investigating the torque-angle properties of the knee by iteratively modifying the hip trajectory until achieving the closest to healthy knee biomechanics by a 3-Degree of Freedom (DOF) Simulator. This research reveals that constant spring stiffness is suboptimal to varying gait requirements for different types of activity, due to the variability of the power requirements of the knee caused by the passive, viscous and elastic characteristics and the activation dependent properties of the muscles. Exploring this variation is crucial for the design of tran

Biomechanics of Prosthetic Knee Systems : Role of Dampening and Energy Storage Systems

One significant drawback of the commercial passive and microprocessored prosthetic devices, the inability of delivering positive energy when needed, is due to the absence of the knee flexion during stance phase. Moreover, consequences such as circumduction and disturbed gait pattern take place due to the improper energy flow at the knee and the absence of the positive energy delivery during the swing phase. Current generation powered design has solved these problems by delivering the needed energy with heavy battery demanding motors, which increase the mass of the device significantly. Hence, the gait quality of transfemoral amputees has not improved significantly in the last 50 years due to the inefficient energy flow distribution causing the patient to hike his/her pelvis, which leads to back pain in the long run. In this context, state-of-art prosthetics technology is trending toward creating energy regenerative devices, which are able to harvest/ return energy during ambulation by a spring mechanism, since a spring not only permits significant power demand reduction but also provides high power-to-weight ratio. This study will examine the sagittal plane knee moment versus knee flexion angle properties robotically, clinically and theoretically to explore the functional stiffness of a healthy knee as well as a prosthetic knee during the energy return and harvest phases of gait. With this intention, a prosthetic knee test method will be developed for investigating the torque-angle properties of the knee by iteratively modifying the hip trajectory until achieving the closest to healthy knee biomechanics by a 3-Degree of Freedom (DOF) Simulator. This research reveals that constant spring stiffness is suboptimal to varying gait requirements for different types of activity, due to the variability of the power requirements of the knee caused by the passive, viscous and elastic characteristics and the activation dependent properties of the muscles. Exploring this variation is crucial for the design of tran

The effect of prefabricated wrist-hand orthoses on grip strength

Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand function. Previous studies report an initial reduction in grip strength with WHO use which may increase following prolonged use. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed, female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm torsiometer were used to measure wrist joint position when maximum grip strength was achieved. The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the quality of fit. The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip strength can improve functional task performance. Therefore while it is important to measure grip strength, it is only one factor to be considered when evaluating the efficacy of WHOs

The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses

Use of stance control knee-ankle-foot orthoses : a review of the literature

The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects of this technology is monitored and evaluated as the demand for evidence based practice and cost effective rehabilitation increases. A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest, Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they addressed the use and effectiveness of commercially available stance control orthotic knee joints and included participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were developed and answered according to the best available evidence: 1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait parameters 2. The effect SCKAFO systems have on the temporal and spatial parameters of gait 3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking. 4. The effect SCKAFO systems have on muscle power/generation 5. Patient’s perceptions/ compliance of SCKAFO systems Although current research is limited and lacks in methodological quality the evidence available does, on a whole, indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice

The Effects of Prosthesis Inertial Properties on Prosthetic Knee Moment and Hip Energetics Required to Achieve Able-bodied Kinematics

There is a major need in the developing world for a low-cost prosthetic knee that enables users to walk with able-bodied kinematics and low energy expenditure. To efficiently design such a knee, the relationship between the inertial properties of a prosthetic leg and joint kinetics and energetics must be determined. In this paper, using inverse dynamics, the theoretical effects of varying the inertial properties of an above-knee prosthesis on the prosthetic knee moment, hip power, and absolute hip work required for walking with ablebodied kinematics were quantified. The effects of independently varying mass and moment of inertia of the prosthesis, as well as independently varying the masses of each prosthesis segment, were also compared. Decreasing prosthesis mass to 25% of physiological leg mass increased peak late-stance knee moment by 43% and decreased peak swing knee moment by 76%. In addition, it reduced peak stance hip power by 26%, average swing hip power by 76%, and absolute hip work by 22%. Decreasing upper leg mass to 25% of its physiological value reduced absolute hip work by just 2%, whereas decreasing lower leg and foot mass reduced work by up to 22%, with foot mass having the greater effect. Results are reported in the form of parametric illustrations that can be utilized by researchers, designers, and prosthetists. The methods and outcomes presented have the potential to improve prosthetic knee component selection, facilitate ablebodied kinematics, and reduce energy expenditure for users of low-cost, passive knees in developing countries, as well as for users of advanced active knees in developed countries.MIT Department of Physics Pappalardo Program (Fellowship)Massachusetts Institute of Technology. Public Service CenterMassachusetts Institute of Technology. Research Support CommitteeNational Science Foundation (U.S.). Graduate Research Fellowship (Grant 1122374)MIT Tata Center for Technology and Desig