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

Effects of Physical Exertion and Alignment Alterations on Trans-Tibial Amputee Gait, and Concurrent Validity of Prosthesis-Integrated Measurement of Gait Kinetics

This study investigated the effects of slight changes in the alignment of the artificial limb of trans-tibial amputees on the walking pattern on the level of forces and moments, particularly when physical exertion levels increase. Two alignment conditions were assessed in ten trans-tibial amputees while walking with low and with strong levels of exertion. Two separate data collection methods were utilized simultaneously: a conventional motion analysis, and continuous recordings from prosthesis-integrated force sensors. While the former was used to compare bilateral leg symmetry across conditions, the latter allowed analyzing unilateral step variability within subjects. This paper presents both analyses in separate chapters. A third chapter addresses the question of concurrent validity of the utilized integrated-sensor-based gait data collection method. Findings indicate that increased physical exertion and prosthesis ankle plantar-flexion angle was related to decreases in step length symmetry, maximal knee flexion angle, knee moment, and dorsi-flexion moment, but had no significant effect on an overall gait symmetry index. It was also shown, that effects were different among participants, with only three of them showing a significant change in parameters measured by the integrated sensor system. Integrated sensor measurements namely of axial force and joint moments were found to be closely correlated to conventional measurements, while pertaining to slightly different biomechanical quantities. The detected effects of alignment perturbations and physical exertion were small in magnitude and inconsistent between participants of our sample population. The concept of a range of acceptable prosthesis alignments, within which no optimization is feasible, is supported. However, amputee gait pattern and responses to alignment perturbations seem to change with the level of exertion. This suggests a consideration of real life conditions for the individual optimization of prosthetic alignment. Provided the systematic limitations of the integrated sensor measurements are carefully considered, it appears possible to use this method for the assessment of individual effects of alignment changes

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 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

Fiber Bragg Gratings as e-Health Enablers: An Overview for Gait Analysis Applications

Nowadays, the fast advances in sensing technologies and ubiquitous wireless networking are reflected in medical practice. It provides new healthcare advantages under the scope of e-Health applications, enhancing life quality of citizens. The increase of life expectancy of current population comes with its challenges and growing health risks, which include locomotive problems. Such impairments and its rehabilitation require a close monitoring and continuous evaluation, which add financial burdens on an already overloaded healthcare system. Analysis of body movements and gait pattern can help in the rehabilitation of such problems. These monitoring systems should be noninvasive and comfortable, in order to not jeopardize the mobility and the day-to-day activities of citizens. The use of fiber Bragg gratings (FBGs) as e-Health enablers has presented itself as a new topic to be investigated, exploiting the FBGs’ advantages over its electronic counterparts. Although gait analysis has been widely assessed, the use of FBGs in biomechanics and rehabilitation is recent, with a wide field of applications. This chapter provides a review of the application of FBGs for gait analysis monitoring, namely its use in topics such as the monitoring of plantar pressure, angle, and torsion and its integration in rehabilitation exoskeletons and for prosthetic control

Inertial sensors-based lower-limb rehabilitation assessment: A comprehensive evaluation of gait, kinematic and statistical metrics

Analysis of biomechanics is frequently used in both clinical and sporting practice in order to assess human motion and their performance of defined tasks. Whilst camera-based motion capture systems have long been regarded as the ‘Gold-standard’ for quantitative movement-based analysis, their application is not without limitations as regards potential sources of variability in measurements, high cost, and practicality of use for larger patient/subject groups. Another more practical approach, which presents itself as a viable solution to biomechanical motion capture and monitoring in sporting and patient groups, is through the use of small-size low-cost wearable Micro-ElectroMechanical Systems (MEMs)-based inertial sensors. The clinical aim of the present work is to evaluate rehabilitation progress following knee injuries, identifying a number of metrics measured via a wireless inertial sensing system. Several metrics in the time-domain have been considered to be reliable for measuring and quantifying patient progress across multiple exercises in different activities. This system was developed at the Tyndall National Institute and is able to provide a complete and accurate biomechanics assessment without the constraints of a motion capture laboratory. The results show that inertial sensors can be used for a quantitative assessment of knee joint mobility, providing valuable information to clinical experts as regards the trend of patient progress over the course of rehabilitation

Sensor Fusion Representation of Locomotion Biomechanics with Applications in the Control of Lower Limb Prostheses

Free locomotion and movement in diverse environments are significant concerns for individuals with amputation who need independence in daily living activities. As users perform community ambulation, they face changing contexts that challenge what the typical passive prosthesis can offer. This problem rises opportunities for developing intelligent robotic systems that assist the locomotion with the least possible interruptions for direct input during operation. The use of multiple sensors to detect the user's intent and locomotion parameters is a promising technique that could provide a fast and natural response to the prostheses. However, the use of these sensors still requires a thorough investigation before they can be translated into practical settings. In addition, the dynamic change of context during locomotion should translate to adjustment in the device's response. To achieve the scaling rules for this modulation, a rich biomechanics dataset of community ambulation would provide a source of quantitative criteria to generate bioinspired controllers. This dissertation produces a better understanding of the characteristics of community ambulation from two different perspectives: the biomechanics of human motion and the sensory signals that can be captured by wearable technology. By studying human locomotion in diverse environments, including walking on stairs, ramps, and level ground, this work generated a comprehensive open-source dataset containing the biomechanics and signals from wearable sensors during locomotion, evaluating the effects of changing the locomotion context within the ambulation mode. With the multimodal dataset, I developed and evaluated a combined strategy for ambulation mode classification and the estimation of locomotion parameters, including the walking speed, stair height, ramp slope, and biological moment. Finally, by combining this knowledge and incorporating both the biomechanics insight with the machine learning-based inference in the frame of impedance control, I propose novel methods to improve the performance of lower-limb robotics with a focus on powered prostheses.Ph.D