Are wearable insoles a validated tool for quantifying transfemoral amputee gait asymmetry?

Background: Amputee gait is known to be asymmetrical, especially during loading of the lower limb. Monitoring asymmetry could be useful in quantifying patient performance during rehabilitation. Wearable insoles can provide normal ground reaction force asymmetry in real-life conditions. Objectives: To characterize the validity of Loadsol® insoles versus force plates in quantifying normal ground reaction force and gait asymmetry. To determine the influence walking speed has on loading asymmetry in transfemoral amputees. Study design: This is a prospective study. Methods: Six transfemoral amputees, wearing Loadsol® insoles, walked at three self-selected speeds on force plates. Validity was assessed by comparing normal ground reaction force data from the insoles and force plates. The Absolute Symmetry Index was used to calculate gait loading asymmetry at each speed. Results: Normalized root mean square errors for the normal ground reaction forces were 6.6% (standard deviation = 2.3%) and 8.9% (standard deviation = 3.8%); correlation coefficients were 0.91 and 0.95 for the prosthetic and intact limb, respectively. The mean error for Absolute Symmetry Index parameters ranged from -2.67% to 4.35%. Loading asymmetry increased with walking speed. Conclusion: This study quantified the validity of Loadsol® insoles in assessing loading asymmetry during gait in transfemoral amputees. The calibration protocol could be improved to better integrate it into a clinical setting. However, our results support the relevance of using such insoles during the clinical follow-up of transfemoral amputees. Clinical relevance: This is the first study to validate Loadsol® insoles versus force plates and report on loading asymmetry during gait at three different speeds in transfemoral amputees. Loadsol® insoles, which provide visual and audio feedback, are clinically easy to use and could have beneficial application in the amputee's rehabilitation and follow-up

Reliability quantification and gait loading asymmetry assessment with wearable insoles in transfemoral amputee people at different speeds

Introduction Amputee people have gait defaults, as for example loading asymmetry, which increase with daily living situations. Replication of realistic daily living environment in a motion analysis laboratory (MAL) is difficult. Wearable pressure insoles, by providing normal ground reaction force (NGrF), can be used to quantify loading gait asymmetry in real life conditions. This asymmetry, considered as an indicator of the quality of the gait, is useful for physicians to monitor the rehabilitation progress or the prosthetic fitting suitability. The study aimed at quantifying the reliability of NGrF measurement and assessing the gait asymmetry of transfemoral amputee people with Pedoped® insoles against force plates. Walking speed effect was also evaluated on gait asymmetry for transfemoral amputee people (TFP). Material and methods In a MAL, five active TFP walked at three self-selected speeds on level ground wearing Pedoped® insoles. Reliability was assessed by comparing NGrF obtained from both systems with Bland-Altman plots, normalized RMSE (NRMSE) and correlation coefficient. Gait loading asymmetry was computed by Absolute Symmetry Index in loading at the three self-selected speeds with insoles. Results The mean NRMSE of NGrF was 7.2% (± 2.8%) and 9.8% (± 3.5%); and coefficient correlation was 0.91 and 0.95 for the prosthetic side and the intact side respectively. Loading asymmetry increased significantly with walking speed for each specific variable of NGrF. Discussion–conclusion After overcoming the calibration problem in amputee population, Pedoped® insoles could be easily used for gait asymmetry follow-up during rehabilitation

Phantom Sensations Influenced by Global and Local Modifications of the Prosthetic Socket as a Potential Solution for Natural Somatosensory Feedback During Walking: A Preliminary Study of a Single Case

Following lower limb amputation, amputees are trained to walk with a prosthesis. The loss of a lower limb deprives them of essential somatosensory information, which is one of the causes of the difficulties of walking with a prosthesis. We here explored whether a solution to this lack of somatosensory feedback could come from natural sensations of the phantom limb, present in most amputees, instead of from substitutive technologies. Indeed, it is known that phantom sensations can be modulated by (i) global mechanical characteristics of the prosthesis socket, and (ii) locally applying a stimulus on an area of the residual limb. The purpose of this pilot study was to verify the feasibility of influencing phantom sensations via such socket modifications in a participant with transfemoral amputation. Four prosthetic interface conditions were studied: a rigid and a semi-rigid socket, each one with and without a focal pressure increase on a specific area of the residual limb. The results show that phantom sensations during walking were different according to the 4 interface conditions. The participant had more vivid phantom sensations in his foot and calf of which some varied as a function of the gait phases. Preliminary gait analysis with wearable sensors shows that these modifications were accompanied by changes in some gait spatiotemporal parameters. This preliminary study of single case demonstrates that phantom sensations can be modulated by the prosthetic interface and can provide natural somatosensory information dynamically varying with gait phases. Although this needs to be confirmed for a larger population of lower limb amputees, it already encourages non-painful phantom sensations to be considered early during the rehabilitation of lower limb amputees

Phantom-Mobility-Based Prosthesis Control in Transhumeral Amputees Without Surgical Reinnervation: A Preliminary Study

Transhumeral amputees face substantial difficulties in efficiently controlling their prosthetic limb, leading to a high rate of rejection of these devices. Actual myoelectric control approaches make their use slow, sequential and unnatural, especially for these patients with a high level of amputation who need a prosthesis with numerous active degrees of freedom (powered elbow, wrist, and hand). While surgical muscle-reinnervation is becoming a generic solution for amputees to increase their control capabilities over a prosthesis, research is still being conducted on the possibility of using the surface myoelectric patterns specifically associated to voluntary Phantom Limb Mobilization (PLM), appearing naturally in most upper-limb amputees without requiring specific surgery. The objective of this study was to evaluate the possibility for transhumeral amputees to use a PLM-based control approach to perform more realistic functional grasping tasks. Two transhumeral amputated participants were asked to repetitively grasp one out of three different objects with an unworn eight-active-DoF prosthetic arm and release it in a dedicated drawer. The prosthesis control was based on phantom limb mobilization and myoelectric pattern recognition techniques, using only two repetitions of each PLM to train the classification architecture. The results show that the task could be successfully achieved with rather optimal strategies and joint trajectories, even if the completion time was increased in comparison with the performances obtained by a control group using a simple GUI control, and the control strategies required numerous corrections. While numerous limitations related to robustness of pattern recognition techniques and to the perturbations generated by actual wearing of the prosthesis remain to be solved, these preliminary results encourage further exploration and deeper understanding of the phenomenon of natural residual myoelectric activity related to PLM, since it could possibly be a viable option in some transhumeral amputees to extend their control abilities of functional upper limb prosthetics with multiple active joints without undergoing muscular reinnervation surgery

Using exoskeletons to assist medical staff during prone positioning of mechanically ventilated COVID-19 patients: a pilot study

International audienceWe conducted a pilot study to evaluate the potential and feasibility of back-support exoskeletons to help the caregivers in the Intensive Care Unit (ICU) of the University Hospital of Nancy (France) executing Prone Positioning (PP) maneuvers on patients suffering from severe COVID-19-related Acute Respiratory Distress Syndrome. After comparing four commercial exoskeletons, the Laevo passive exoskeleton was selected and used in the ICU in April 2020. The first volunteers using the Laevo reported very positive feedback and reduction of effort, confirmed by EMG and ECG analysis. Laevo has been since used to physically assist during PP in the ICU of the Hospital of Nancy, following the recrudescence of COVID-19, with an overall positive feedback

APSIC: Training and fitting amputees during situations of daily living

Today, the prevalence of major amputation in France can be estimated between 90,000 and 100,000 and the incidence is about 8300 new amputations per year (according to French National Authority for Health estimation). This prevalence is expected to increase in the next decade due to the ageing of the population. Even if prosthetic fitting allows amputee people recovering the walking ability, their autonomy remains limited when crossing obstacles such as slopes, stairs or cross-slopes frequently encountered during outdoors displacements. The aim of the project APSIC was to complete scientific knowledge about adaptation strategies to situations of daily living compared to level walking through an extensive motion analysis study of transtibial and transfemoral amputee compared to non-amputee people. APSIC succeeded in identifying physiologic joint functions and current prosthetic joint limitations in the studied situations, which notably resulted in the design of a prototype of ankle-knee prosthesis adapted to multimodal locomotion of transfemoral amputee. Perspectives of the clinical use of motion analysis within the rehabilitation process were explored and proved to be relevant for personalized approach of motor learning

Le phénomène d exclusion segmentaire du membre supérieur chez l adulte (description et approches thérapeutiques conventionnelle et par miroir)

Le diagnostic clinique du syndrome d'exclusion est souvent tardif; à l'origine de séquelles par retard thérapeutique. S'appuyant sur la littérature et sur une série d'exclus du membre supérieur, l'ensemble des signes constitutifs du phénomène d'exclusion sont exposés, et les signes cliniques cardinaux à rechercher sont mis en exergue. Les données récentes de la pathogénie et des enchaînements physiopathologiques sont présentés. Ces réflexions théoriques sont à l'origine des thérapeutiques nouvelles par leurre sensoriel. L'.étude interventionnelle comporte des thérapies conventionnelles et par miroir, Les résultats témoignent de l'efficacité d'une approche globale intégrant les concepts utilisés en réadaptation de pathologies locomotrices périphériques et neurologiques centrales. Des programmes plus complets d'imagerie motrice sont un nouvel espoir pour les patients souffrant de phénomène d'exclusion.NANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Le fauteuil roulant chez le blessé médullaire, facteur déterminant de l'insertion sociale. État des lieux et effets de la locomotion en dévers sur les astreintes physiologiques

Introduction. Les capacités et les possibilités de déplacement en fauteuil roulant manuel (FRM) sont déterminantes pour l'intégration sociale et professionnelle des usagers. Objectifs. Approfondir la connaissance des contraintes de déplacement en FRM à travers 2 études. La 1ère pour identifier les habitudes et préciser les difficultés des usagers ; la 2nde, induite par les résultats de la 1ère, pour évaluer les effets du dévers, encore méconnus, sur les astreintes cardiaques, énergétiques, musculaires et subjectives. Méthodes. La 1ère étude a été menée par questionnaire complété par 118 sujets paraplégiques en FRM. La 2nde étude, en laboratoire avec 25 hommes paraplégiques, comporte 2 tests : un test d?effort sur ergocycle à bras et un test de propulsion de 300 m et 8 conditions combinant 4 dévers (0, 2, 8 et 12 %) et 2 vitesses (0,97 m.s-1 et une vitesse choisie "de confort"). Résultats. La 1ère étude révèle un environnement peu adapté, avec des moyens de transport et des bâtiments souvent inaccessibles sans aide, et des gènes limitant les sorties des usagers parmi lesquelles figure le dévers. La 2nde étude indique des astreintes cardiaques, énergétiques et musculaires significativement modifiées par le dévers et par la vitesse (p < 0,01). L'astreinte subjective n'est pas modifiée par la vitesse. Des différences entre 0 et 2 % sont faibles mais existent. Un dévers de 12 % est difficilement réalisable. Les équilibres des activités musculaires changent dès 2 % de dévers. Le niveau lésionnel modifie de façon très importante les stratégies de déplacements et les niveaux d'astreintes mesurées ou perçues. Discussion-Conclusion. Les effets du dévers sont perceptibles dès 2 % et sont nets et délétères à 8 %. Ce travail permet de proposer de façon plus argumentée un modèle d'astreintes qui conforte le seuil de dévers fixé réglementairement à 2 % permettant à la grande majorité des usagers de FRM de se déplacer de façon autonome et de rester actifsIntroduction. Displacement capacities and possibilities in manual wheelchair (MWC) are strong determinants of social and occupational integration of MWC users. Objectives. Improve the knowledge of the strains involved by displacement in MWC through 2 studies; the first one to identify habits and difficulties of MWC users. The second one, induced by the results of the first one, has assessed the poorly known cardiac, energetic, muscular and subjective strains of the displacement of MWC users on a cross slope. Methods. The first study was a survey answered by 118 paraplegics habitual MWC users. The second one, a laboratory study conducted with 25 paraplegic men, includes 2 tests: a sub maximal arm-cranking test and a 300 m propulsion test with 8 conditions combining 4 cross slopes (0, 2, 8 et 12%) and 2 velocities (0,97 m.s-1 and a "comfortable" chosen one). Results. The first study shows an adverse environment, with many places unreachable without help and disturbances, like cross slope, which hinders users' displacements. The second study demonstrates the increases of cardiac, energetic, muscular and subjective strains with cross slope. Differencies between 0 and 2% cross slopes are low but quantified. Displacement on a 12% cross slope is very difficult. The balance of muscles activities is changing at 2% cross slope. The injury level makes deep changes in the displacements strategies and in as well perceived as measured strain levels. Discussion-Conclusion. Effects of cross slope are perceived for as low as 2% and onwards values. They are high and deleterious at 8%. This work allows to construct a model of cross slope strains which confirms that the regulatory 2% cross slope limit is well chosen because it allows most MWC users to move without help and remain activeMETZ-SCD (574632105) / SudocNANCY1-Bib. numérique (543959902) / SudocNANCY2-Bibliotheque electronique (543959901) / SudocNANCY-INPL-Bib. électronique (545479901) / SudocSudocFranceF