Performance evaluation of Jaipur knee joint through kinematics gait symmetry with unilateral transfemoral Indian amputees

Human gait data becomes very helpful in the prediction and correction of movement control while walking. In many areas like medical practices, Physical fitness training programs, rehabilitation techniques and prosthesis performance, gait study has its significant scientific relevance and applications. This study aims to predict the performance of Jaipur knee joint in terms of gait symmetry with transfemoral Indian amputees. First time we tried to calculate gait symmetry of widely used Jaipur knee joint with Indian population. This aspect has not been focused so far with Indian amputees. 11 unilateral transfemoral amputees (9 men and 2 women; average age 45 years, range 31-58 years) participated in the study. Subjects were using prosthesis with Jaipur knee for long time (mean: 16 yrs; range: 5-27 yrs). To investigate the gait function with 6 Vicon cameras 3D motion analysis system (Kinematrix system) participants were asked to walk with their comfortable speed. Gait symmetry, might be the basis of recommendation of knee joint. Kinematics parameter is predicted quantitavely gait symmetry with Jaipur knee joint. This research will result in significant prevention of degenerated musculoskeletal effects in future generally seen in unilateral transfemoral amputees

Identification of design requirements for a high-performance, low-cost, passive prosthetic knee through user analysis and dynamic simulation

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2013.Cataloged from PDF version of thesis.Includes bibliographical references.In January 2012, a partnership was initiated between the Massachusetts Institute of Technology and Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS, a.k.a., Jaipur Foot) to design a high-performance, low-cost, passive prosthetic knee for transfemoral amputees in India. The knee was primarily intended to improve the walking gait of amputees relative to existing low-cost devices. This thesis aimed to identify detailed design requirements for the prosthetic knee through user analysis and dynamic simulation. User analysis identified the needs and constraints of numerous stakeholders in the prosthesis development process. Members of the Indian biomechanics, prosthetics, and rehabilitation communities were interviewed to identify general requirements for the design, manufacturing, evaluation, and fitting of a prosthetic knee, and a structured survey of Indian amputees was conducted to quantify the demographics, functional capabilities, and functional needs of future end users. Dynamic simulation identified methods to enable transfemoral amputees to walk with reduced energy expenditure and normative gait kinematics. 2-dimensional inverse dynamics simulations were used to calculate the effects of inertial alterations of a prosthetic leg on the energy expenditure required to walk with normative kinematics. In addition, simulations were performed to compute the effects of inertial alterations on the knee moment required to walk with normative kinematics. Mechanical power analysis, sensitivity analysis, and optimization were used to formulate a passive mechanical model that could accurately reproduce the specified knee moment. The effects of walking cadence on critical results were also examined. Through the identification of user-centered and biomechanical requirements, the thesis provides a blueprint for the mechanism design comprising the next phase of the project.by Yashraj S. Narang.S.M

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 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

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

Development and validation of a novel framework for designing and optimizing passive prosthetic feet using lower leg trajectory

Thesis: Ph. D., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2018.Cataloged from PDF version of thesis.Includes bibliographical references.This thesis presents a novel framework to optimize the design of passive prosthetic feet to best replicate physiological lower leg trajectory under typical ground reaction forces. The goal of developing this framework is ultimately to design a low cost, mass manufacturable prosthetic foot for persons with amputations living in the developing world. Despite a vast body of literature on prosthetic foot design, there is a dearth of knowledge regarding how the mechanical characteristics of passive prosthetic feet affect their biomechanical performance. Without understanding this relationship, the design of a prosthetic foot cannot be optimized for peak performance as measured by gait symmetry, metabolic cost of walking, or subjective feedback. The approach to designing prosthetic feet introduced here involves predicting the lower leg trajectory for a given prosthetic foot under typical loading and comparing this modeled trajectory to target physiological gait kinematics with a novel metric called the Lower Leg Trajectory Error (LLTE). The usefulness of this design approach was demonstrated by optimizing three simple conceptual models of prosthetic feet, each with two degrees of freedom. An experimental prosthetic foot with variable ankle stiffness was built based on one of these analytical models and tested by a subject with unilateral transtibial amputation in a gait lab under five different ankle stiffness conditions. Across five prosthetic-side steps with each of the five ankle stiffness conditions, the constitutive model used in the optimization process accurately predicted the horizontal and vertical position of the knee throughout stance phase to within an average of 1.0 cm and 0.3 cm, respectively, and the orientation of the lower leg segment to within 1.5°. After validating the theory behind this approach with the simple conceptual foot models, a method was developed to implement the same approach in optimizing the shape and size of a single-part compliant foot, resulting in a lightweight, easy to manufacture, low cost prosthetic foot. The optimal prosthetic foot design was built and tested qualitatively on six subjects in India with unilateral transtibial amputations with promising preliminary results..by Kathryn M. Olesnavage.Ph. D