http://opmarketing.com/storage/Research%20EncyclOPedia/Microprocessor%20Knees/Hafner-%20APMR%202007.pdf

Evaluation of Function, Performance, and Preference as Transfemoral Amputees Transition From Mechanical to Microprocessor Control of the Prosthetic Knee

Objective: To review the influence of physical capacity on regaining walking ability and the development of walking ability after lower limb amputation.Design: A systematic search of literature was performed. The quality of all relevant studies was evaluated according to a checklist for statistical review of general papers.Subjects: Lower limb amputees.Main measures: Physical capacity (expressed by aerobic capacity, anaerobic capacity, muscle force, flexibility and balance) and walking ability (expressed by the walking velocity and symmetry).Results: A total of 48 studies that complied with the inclusion criteria were selected. From these studies there is strong evidence for deterioration of two aspects of physical capacity (muscle strength and balance) and of two aspects of walking ability (walking velocity and symmetry) after lower limb amputation. Strong evidence was found for a relation between balance and walking ability.Conclusion: Strong evidence was only found for a relation between balance and wa...

/pdf/physical-capacity-and-walking-ability-after-lower-limb-4iwrvbtik9.pdf

Physical capacity and walking ability after lower limb amputation: a systematic review

Objective: t o investigate factors that predict walking with a prosthesis after lower limb amputation. Design: Systematic literature review. Methods: A computer-aided literature search of MeDliNe, eMBASe, ciNAHl and the cochrane library was per formed to identify studies published up to August 2007 that investigated factors that predicted walking ability after lower limb amputation. Results: A total of 57 studies were selected. Predictors of good walking ability following lower limb amputation include cognition, fitness, ability to stand on one leg, independence in activities of daily living and pre-operative mobility. longer time from surgery to rehabilitation and stump problems are predictors of poor outcome. the impact of the cause of amputation on walking varies between studies. in gener al, unilateral and distal amputation levels, and younger age were predictive of better walking ability. Sex probably does not have a significant influence on walking ability. Conclusion: the heterogeneity of methods and outcome measures used in the identified studies make comparison difficult and, in part, explains conflicting conclusions in relation to predictive factors. Further investigation of predictive factors is needed to estimate walking potential more accurately and guide targeting of modifiable factors to optimize outcome after lower limb amputation.

/pdf/predicting-walking-ability-following-lower-limb-amputation-a-1m51puwvc0.pdf

Predicting walking ability following lower limb amputation: a systematic review of the literature.

Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review

Background Use of outcome measures to examine outcomes of amputation is complicated by a number of factors, including ease of administration and lack of scientific evidence to guide selection and interpretation.

Objective The purposes of this study were: (1) to estimate test-retest reliability of a modified version of the Prosthetic Evaluation Questionnaire (PEQ), scales of a version of the 36-Item Short-Form Health Survey questionnaire adapted for the veteran population (SF-36V), the Orthotics and Prosthetics Users' Survey (OPUS), the Patient-Specific Functional Scale (PSFS), the Two-Minute Walk Test, the Six-Minute Walk Test, the Timed “Up & Go” Test, and the Amputee Mobility Predictor; (2) to calculate minimal detectable change (MDC) of each measure; and (3) to conduct item analysis of the modified PEQ.

Design This was a multi-site study with repeated measurements.

Methods Forty-four patients with unilateral lower-limb amputation participated. Participants were tested twice within 1 week. We calculated test-retest reliability of each measure using intraclass correlation coefficient (ICC [2,1]), estimated standard error of the measurement and MDC, and assessed scale score distribution.

Results The study demonstrated strong test-retest reliability scores of performance measures (ICC=.83–.97) suggesting that these measures are good choices for evaluation of people with lower-limb amputation. Reliability of PEQ subscales (ICC=.41–.93) was comparable to that reported in the literature (ICC=.56–.90).

Limitations This study examined only statistically measurable differences and did not evaluate whether changes in scores were clinically important.

Conclusions Minimal detectable change scores can be used to determine whether change in test scores exceeds measurement error associated with day-to-day variation. This is the first study to present test-retest reliability data on the self-reported OPUS scales, the PSFS in people with lower-limb amputations, and a new, easier-to-use scoring mechanism for the PEQ.

Reliability of Outcome Measures for People With Lower-Limb Amputations: Distinguishing True Change From Statistical Error

Chin T, Sawamura S, Fujita H, Nakajima S, Oyabu H, Nagakura Y, Ojima I, Otsuka H, Nakagawa A: Physical fitness of lower limb amputees. Am J Phys Med Rehabil 2002;81:321–325.ObjectiveTo investigate the cardiorespiratory endurance of the physical fitness of amputees and able-bodied subjects of

Physical fitness of lower limb amputees.

The purpose of this study was to investigate the characteristic differences between the IP and C-Leg by making a comparative study of energy consumption and walking speeds in trans-femoral amputees. The subjects consisted of four persons with traumatic trans-femoral amputations aged 17 - 33 years who had been using the IP and were active in society. Fourteen able-bodied persons served as controls. First the energy consumption at walking speeds of 30, 50, 70, and 90 m/min was measured when using the IP. Then the knee joint was switched to the C-Leg. The same energy consumption measurement was taken once the subjects were accustomed to using the C-Leg. The most metabolically efficient walking speed was also determined. At a walking speed of 30 m/min using the IP and C-Leg, the oxygen rate (ml/kg/ min) was, on average, 42.5% and 33.3% higher (P< 0.05) than for the able-bodied group. At 50 m/min, the equivalent figures were 56.6% and 49.5% (P< 0.05), while at 70 m/min the figures were 57.8% and 51.2% (P<0.05), and at 90m/min the figures were 61.9% and 55.2% (P<0.05%). Comparing the oxygen rates for the subjects using the IP and C-Leg at walking speeds of 30 m/min and 90 m/min it was found that subjects who used C-Leg walked somewhat more efficiently than those who used IP. However, there was no significant difference between the two types at each walking speed. It was also determined that the most energy-efficient walking speed for subjects using the IP and C-Leg was the same as for the controls. Although the subjects in this study walked with comparable speed and efficiency whether they used the IP or C-Leg, the subjects' energy consumption while walking with the IP and C-Leg at normal speeds were much lower than previously reported. This study suggested that the microprocessor controlled knee joints appeared to be valid alternative for improving walking performance of trans-femoral amputees.

Comparison of different microprocessor controlled knee joints on the energy consumption during walking in trans-femoral amputees: intelligent knee prosthesis (IP) versus C-leg.

Objective: To make a comparative study of energy expenditure and walking speeds between able-bodied people and young Intelligent Prosthesis (IP) users and to demonstrate the effect of IP on the walking ability of young amputees. Design: The test subjects were eight young traumatic transfemoral amputees. Fourteen able-bodied persons served as controls. All amputees used an IP, and they had all undergone a prosthetic rehabilitation program for 8 wk. IP users, who had completed the rehabilitation program, were instructed to walk at speeds of 30, 50, 70, 90, and 110 m/min. Measurements of energy expenditure while walking were taken. The most metabolically efficient waking speed was also determined. Results: On average, the IP users experienced an oxygen uptake that was 24.1% and 24.2% higher than those for the controls at speeds of 70 and 90 m/min, respectively. It was also determined that the most metabolically efficient walking speed for the IP users was the same as for the controls. Conclusions: This study showed that young IP users who undergo an adequate prosthetic rehabilitation program can achieve remarkably improved walking performance. Young IP users could walk at the normal speeds of able-bodied people, with only around a 24% increase in energy expenditure.

Effect of an Intelligent Prosthesis (IP) on the walking ability of young transfemoral amputees: comparison of IP users with able-bodied people.

We have already reported that the one-leg cycling test driven by the subject's sound leg as the exercise load test is effective in measuring the anaerobic threshold (AT) of unilateral lower limb amputees. The aim of this research is to investigate whether or not endurance training based on each subject's AT gained from the one-leg cycling test is useful in improving the physical fitness of lower limb amputees. The test subjects were all unilateral transfemoral amputees comprising a group of 14 undertaking endurance training and a control group of 10. The form of endurance training is driving an ergometer with the sound limb only in the same way as the load test. The training program was designed so that the subjects would exercise at a target heart rate corresponding to AT point for 30 minutes per day, 3-5 days each week for 6 weeks. After the training periods, in the training subjects the AT and maximum oxygen uptake (__O2max) increased significantly. The rate of increase averaged 36.5%, 26.0%, respectively, compared to their levels before the training. On the contrary, no changes occurred in the control subjects. These results suggest that our chosen training program based on each subject's AT is effective in improving the physical fitness of lower limb amputees.

Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees.

The Intelligent Prosthesis may enable lower limb amputees to walk faster than with conventionally damped prostheses and as a result the physical burden involved in walking could be expected to be considerably higher. The aim of this study was to investigate whether or not physiological cost index (PCI) is applicable as an indicator for monitoring the amount of exercise load involved in walking with an Intelligent Prosthesis. The method used a treadmill and monitored gas exchange, ventilation and heart rate (HR) in 6 unilateral trans-femoral amputees, ages were between 17 and 34 with an average age of 23.1. The exercise protocol was as follows: for each person speeds at 0.8 times the subject's free level walking speed, 1.0 times, 1.2 times, 1.4 times and for some 1.6 times were applied. In each case the index of correlation between PCI and oxygen uptake in response to walking speed was calculated. A significant correlation was observed between PCI and oxygen uptake in each case, which indicated a close relationship between cardiopulmonary factor and energy consumption while walking. These results suggest that PCI is of use as an indicator for ascertaining the amount of exercise load in walking with an Intelligent Prosthesis.

/pdf/the-efficacy-of-physiological-cost-index-pci-measurement-of-4e95me0vy7.pdf

Hiroko Oyabu

Papers

Physical fitness of lower limb amputees.

Comparison of different microprocessor controlled knee joints on the energy consumption during walking in trans-femoral amputees: intelligent knee prosthesis (IP) versus C-leg.

Effect of an Intelligent Prosthesis (IP) on the walking ability of young transfemoral amputees: comparison of IP users with able-bodied people.

Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees.

The efficacy of physiological cost index (PCI) measurement of a subject walking with an Intelligent Prosthesis