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Rehabilitation Engineering Part 2 > L21 Lower Limb Prosthetics > Flashcards

L21 Lower Limb Prosthetics Flashcards

1
Q

Epidemiology and Cost of Prosthetics

A
  • Each year there are 185,000 amputations that have a cost of over 8.3 billion dollars
  • Main causes for these amputations are vascular diseases that take up 54 percent of the amputee
    population and 45 percent of the causes are due to trauma.
  • # of amputations due to diabetes increased by 24% from 1988 to 2009
  • Traditional lower limb prostheses: $5,000 to $50,000
  • Traditional upper limb prosthesis: $3,000 to $30,000 dollars.
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2
Q

Leading Causes of Lower Extremity Amputations

A
  • Peripheral Vascular Disease – infection, foot ulcer
  • Diabetes – infection, foot ulcer
  • Trauma
  • Tumor/Cancer - osteosarcoma
  • Congenital Deficiency
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3
Q

Amputation Levels

A
  • Transtibial amputation: below the knee (BK)
  • Transfemoral amputation: above the knee (AK)
  • Hip, knee, or ankle disarticulation
  • Partial foot, or toe
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4
Q

Components of a Lower Limb
Prosthesis

A
  • Suspension
  • Socket Design
  • Alignment
  • Pylon
  • Prosthetic knees
  • Prosthetic feet
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5
Q

Component Selection

A
  • Patient’s Limb: skin, muscle function, tolerance
  • Amputation level
  • Type of trauma or injury: frostbite, land mines,
    congenital
  • Gender, age
  • Developed or developing countries
  • Occupation
  • Leisure activities
  • Cost/Reimbursement
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6
Q

Fitting process

A
  • Assess Individual Needs (Active, Weight, Occupation, Health)
  • Cast/Scan of the Limb for Model
  • Check Socket made from Model (2-3 weeks of use and appropriate changes)
  • Definitive Prosthesis (After completing physical therapy)
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7
Q

Socket Suspension and Fit

A
  • Stump socks: protection, comfort, absorb
    sweat
  • Vacuum (negative pressure by drawing skin and soft tissues to walls of socket)
  • More constant socket pressure
  • High fidelity socket (Biodesigns)
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8
Q

Recent Innovations:
Lower Limb Prosthetics

A
  • Bluetooth technology
  • Microprocessor knees
  • Prosthetic Materials
  • Osseointegration
  • CAD/CAM technology
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9
Q

Modern Prosthetic Materials

A

Plastic Polymer Laminates (Thermosets):
- Fabrication of prosthetic sockets
- Lightweight and strong
- Acrylic, epoxy, polyester
- Prosthetist has control over:
strength, thickness and stiffness
- Reinforcement fibers: Fiberglass, nylon, Dacron, carbon, Kevlar

Carbon fiber
- Used for prosthetic feet
- More life-like material
- Oscar Pistorius – Bilateral Amputee – carbon fiber-composite legs

Titanium
- Osseointegration – titanium bolt inserted into bone at the end of the stump prosthetics knees, feet, component

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10
Q

Bluetooth technology

A

Sensors on the sound limb can help control prosthetic device

Important for bilateral amputees – two prosthetic legs can commute with each other

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11
Q

Microprocessor Knees

A

Use sensors (force, accelerometer, gyroscope) and a microprocessor (on board computer) to adjust the knee.

  • Swing control or
  • Stance and Swing control
  • Active - Motor powered: aids with flexion or extension or both; provides a knee torque
  • Semi Active - No motors: adjusts the flow of hydraulic fluid in the knee to change the joint resistance
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12
Q

OttoBock Genium

A

Semi-Active (No motors)

Adjusts the flow of hydraulic fluid within the leg from sensory data through the microprocessor

Swing phase: hydraulically controlled

Stance phase: dampening

Complex sensory system :
* Gyroscope
* Accelerometer
* Knee Angle
* Force Sensors – any loading of foot and ankle

Sophisticated Control for:
* Stairs
* Ramps
* Obstacles
* Speed Changes
* Backwards Walking

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13
Q

Ossur Power Knee

A

Active (motor-powered)

First Commercial Active Knee:
* Active Flexion / Extension
* Accelerometer
* Gyroscopes
* Force Sensors

Sophisticated Control for:
* Maintains walking speeds.
* Assists with the upward motion required for stairs and inclines.
* Learns unique patterns of
gait for natural, efficient motion.

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14
Q

Microprocessor Controlled Active Ankle Units

A

Ossur: PROPRIO FOOT
* Advanced sensors with complex control
* Powered ankle motion
* Intelligent terrain adaptation
* Natural function
* High precision linear actuator receives commands via a control board

iWalk: BiOM - Hugh Herr – MIT Media Lab
* Power Plantar Flexion reduces common aches
* Power added to the toe-off to reduce amount of energy required during gait
* BiOM absorbs impact and reduces unnatural forces on the body

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15
Q

Prosthetic Feet

A

*Rigid keel
*Single-axis foot
*Multiaxis foot
*Flexible keel
*Energy-storing foot/dynamic response

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16
Q

Osseointegration

A
  • Integrates titanium implants ->medullary cavity of the bone

Benefits:
* Extend from bone through the skin to create an anchor for prosthesis
* Bypasses skin contact with skin -> reducing pain and tissue damage
* Improved perception of prosthesis

Risks:
* Remove barrier function of skin -> possible contamination
* May lead to infection and metal corrosion
* More surgery

17
Q

CAD/CAM

A
  • Computer Aided Design and Manufacturing
  • Generate quantitative mathematical model of the residual limb
  • More robust systems use CT scans or MRI
  • Increased repeatability of socket deign
  • Extended prosthetic service for the developing world
18
Q

Tools to Evaluate K-Levels

A
  • Amputee Mobility Predictor
    (AMP)
  • Patient Assessment Validation Evaluation Test
    (PAVET)
  • Prosthesis Evaluation
    Questionnaire (PEQ)
  • Timed Up and Go (TUG)
  • Timed Walk Test
  • Distance Walk Test
19
Q

Outcome Measures in Clinic

A

Benefits:
* Justify selection of interventions
* Helps focus the intervention
* Help direct the plan of care
* Determine and predict progress/outcomes
* Improve patient outcomes
* Enhance communication with patients
* Helps to motivate the patient
* Document patient status
* Help decrease insurance denials

Limitations:
* Takes too much time for
patients/clinicians to complete
* Too much time to analyze, calculate or score
* Are difficult to interpret
* Provide information that is too subjective
* Do not help direct the plan of care
* Require more effort than they are worth
* Lack applicability to LLAs

20
Q

Lower Limb Prosthetic Research

A
  • Sit to Stand: Comparing Various Knees
  • C-leg vs. Genium Comparison
  • Prosthetic Feet Comparison
    -> Return to Duty
  • Monitoring Prosthetic and
    Orthotic Function in the Community
21
Q

Sitting and Standing in
Transfemoral Amputees

A
  • Side by side comparison of healthy control subjects and subjects with difference prosthetic knees
  • Determine the ability of different prosthetic knees to assist with sitting and standing
  • 3 types of prosthetic knees were evaluated :
  • The Ossur Power Knee
  • The Otto Bock C-Leg
  • The Mauch Swing and Stance
22
Q

Sitting and Standing in Transfemoral Amputees

A

Despite advances in prosthetic knees in gait, support during standing and sitting were found to be performed primarily by the intact leg.

Current generation prosthetic knees have the capability to provide kinetic
symmetry, but limitations in control, training, or confidence impede their capability.

23
Q

Gait Biomechanics:

A
  • Overground walking (VS, S, N, F)
  • Weighted Walking (VS, S, N, F)
  • 5° Ramp Ascent and Descent (S, N, F)
  • 10° Ramp Ascent and Descent (S, N, F)
  • Walking on Un-Even Terrain (Gravel)
  • Walking Backwards
  • Stair Ascent and Descent
24
Q

Prosthetic Research with Wounded Warriors

A
  • 14 Highly active transtibial amputees
  • Heart rate and speed on SWAT Obstacle course.
  • VO2 , Heart Rate, and Lower body motion tracking used in walking and running in Physical Therapy biomechanics lab.
  • 14 Highly active transtibial amputees
  • Heart rate and speed on SWAT
    Obstacle course.
  • VO2 , Heart Rate, and Lower body motion tracking used in walking and running in Physical Therapy biomechanics lab.
25
Q

Lower Limb Prosthetic Research with CAREN

A

Motivation:
* In U.S. over 2 million with limb loss, will double
by 2050
* Healthcare costs > $100,000 per year
* Prosthesis rejection and underuse due to
comfort, fit, function
* Most outcome measures are subjective
* Return to Duty, Continue on Active Duty

Applications:
* Assessment
* Outcome Measures
* Optimal Prescription/ Function
* Gait Training
* Rehabilitation
* Compare prosthetic components

26
Q

Human Body Model and Gait Reports

A
  • Both subject and operator can visualize human avatar in real-time
  • Provides real-time gait parameters and feedback to patientand clinician allowing for immediate adjustment to gait and balance during the session
  • After testing or training can output a clinical gait report

Rehabilitation Engineering Part 2 (11 decks)

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