Pilot testing of a variable stiffness transverse plane adapter for lower limb amputees.

Amputees often experience soft tissue breakdown and discomfort from the high transverse plane shear stresses between the residual limb and prosthesis. To evaluate the effects of varying the transverse plane stiffness, a small sample population of lower limb amputees wore a novel variable stiffness torsion adapter (VSTA). Peak transverse plane moments were evaluated for three fixed stiffness levels (compliant: 0.30Nm/°, intermediate: 0.57Nm/°, stiff: 0.91Nm/°) while participants traversed five tasks of daily living that emphasize transverse plane motion including: straight walking for reference, 90° turns, 180° turns, a static reach test, and the L-Test of functional mobility. Results indicated that activities requiring high levels of transverse plane motion (90° and 180° turns) had significantly reduced peak transverse plane moments when walking with the compliant transverse plane stiffness as compared to the stiff setting. Additionally, use of the VSTA resulted in no measurable loss of mobility at self-selected walking speeds between the three settings. These preliminary results indicate that a transverse rotation adapter with variable stiffness capability could be useful for a lower limb amputee to help reduce stresses at the socket-limb interface that result in soft tissue breakdown and discomfort.

[1]  S. Rithalia,et al.  The biomechanical effects of the inclusion of a torque absorber on trans-femoral amputee gait, a pilot study , 2002, Prosthetics and orthotics international.

[2]  Kathryn Ziegler-Graham,et al.  Estimating the prevalence of limb loss in the United States: 2005 to 2050. , 2008, Archives of physical medicine and rehabilitation.

[3]  S. Gard,et al.  The human ankle during walking: implications for design of biomimetic ankle prostheses. , 2004, Journal of biomechanics.

[4]  R. Stein,et al.  Turning strategies during human walking. , 1999, Journal of neurophysiology.

[5]  Kartheek Yalamanchili,et al.  Use of a load cell and force–moment curves to compare transverse plane moment loads on transtibial residual limbs: A preliminary investigation , 2014, Prosthetics and orthotics international.

[6]  Glenn K. Klute,et al.  Design of Lower Limb Prosthesis Transverse Plane Adaptor With Variable Stiffness , 2015 .

[7]  P. Watson,et al.  The effect of changing the inertia of a trans-tibial dynamic elastic response prosthesis on the kinematics and ground reaction force patterns , 1997, Prosthetics and orthotics international.

[8]  P Dabnichki,et al.  A three-dimensional biomechanical comparison between turning strategies during the stance phase of walking. , 2005, Human movement science.

[9]  Greta C Bernatz,et al.  Video task analysis of turning during activities of daily living. , 2007, Gait & posture.

[10]  W. Miller,et al.  The L test of functional mobility: measurement properties of a modified version of the timed "up & go" test designed for people with lower-limb amputations. , 2005, Physical therapy.

[11]  J. Lehmann,et al.  Mass and mass distribution of below-knee prostheses: effect on gait efficacy and self-selected walking speed. , 1998, Archives of physical medicine and rehabilitation.

[12]  J. S. Rietman,et al.  Gait analysis in prosthetics: Opinions, ideas and conclusions , 2002, Prosthetics and orthotics international.

[13]  Michael S Orendurff,et al.  Transtibial amputee joint rotation moments during straight-line walking and a common turning task with and without a torsion adapter. , 2009, Journal of rehabilitation research and development.

[14]  Levy Sw.  Amputees: skin problems and prostheses. , 1995 .

[15]  Joan E Sanders,et al.  Transtibial energy-storage-and-return prosthetic devices: a review of energy concepts and a proposed nomenclature. , 2002, Journal of rehabilitation research and development.

[16]  John G Buckley,et al.  Oxygen consumption during ambulation: comparison of using a prosthesis fitted with and without a tele-torsion device. , 2002, Archives of physical medicine and rehabilitation.

[17]  D. Kerrigan,et al.  Predicting peak kinematic and kinetic parameters from gait speed. , 2003, Gait & posture.

[18]  A. Segal,et al.  Does a Torsion Adapter Improve Functional Mobility, Pain, and Fatigue in Patients with Transtibial Amputation? , 2014, Clinical orthopaedics and related research.

[19]  J. Donelan,et al.  Mechanical and metabolic requirements for active lateral stabilization in human walking. , 2004, Journal of biomechanics.

[20]  Glenn K. Klute,et al.  Mechanical Behavior of the Human Ankle in the Transverse Plane While Turning , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[21]  C W Radcliffe,et al.  Functional analysis of the UC-BL shank axial rotation device1 , 1977, Prosthetics and orthotics international.

[22]  Steven A Gard,et al.  The Effects of Increased Prosthetic Ankle Motions on the Gait of Persons with Bilateral Transtibial Amputations , 2010, American journal of physical medicine & rehabilitation.

[23]  G K Klute,et al.  Comparison of human turning gait with the mechanical performance of lower limb prosthetic transverse rotation adapters , 2005, Prosthetics and orthotics international.