Prosthetics: Lower Limb 1 20:00 - 21:00 Monday, 1st November, 2021 Prosthetics: Lower Limb Free Paper Session Carlos Galván Duque Gastélum, Noah Rosenblatt
Hemipelvectomy and Hip Disarticulation Prostheses: A Scoping Review
Hossein Gholizadeh1, Natalie Baddour2, Michael Botros3, Kelly Brannen3, Farshad Golshan3, Edward Lemaire4 1Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada, Ottawa, Canada. 2Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada, Ottawa, Canada. 3Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada., Ottawa, Canada. 4Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada., Ottawa, Canada
Primary topic
Other Topics (to be specified below)
BACKGROUND
Although the global population with hemipelvectomy (HP) or hip disarticulation (HD) is small compared to people with transfemoral or transtibial amputation, the degree of disability is much greater, with functional and independence concerns. People with an amputation at the hip or pelvis have the most difficulty returning to walking because their prosthesis must replace the hip, knee, and ankle joints. A comprehensive literature review is needed to examine the research surrounding prostheses for hip-level amputation.
AIM
To summarize available research that can enhance clinicians’ understanding of hip disarticulation and hemipelvectomy prostheses.
METHOD
An electronic search was conducted to find HP or HD prosthesis-related research articles using Google Scholar, PubMed, Scopus, and Web of Science databases. The date range was 1950 to September 2020. Boolean searching techniques were used and search keywords were (“hip disarticulation” OR “hemipelvectomy”) AND (“amputee”) AND ("prosthesis" OR “artificial limb” OR “socket” OR “design”). Studies were included if they evaluated HD or HP prostheses (retrospectively or prospectively) and were written in English. Conference papers and theses were not included in this review. Study design and protocol, research instrument, sample size, and outcome measures were reviewed.
RESULTS
After removing duplicate articles and studies that did not meet the selection criteria, 53 articles were identified. The research evaluated effects of prostheses on people with HD (30 articles), HP (13 articles), both amputation levels (7 articles), and no amputation (3 articles). Most of the studies were performed in the USA (24) and Japan (9). Eighteen research articles had only one participant and 14 studies were case series with five or fewer participants. In 42 articles, authors prospectively evaluated a HD or HP prosthesis. On average, prospective studies had 4 (SD=5) participants. Since 1950, only five prospective studies evaluated HD or HP prostheses with 10 or more participants. Available articles in the literature evaluated one or more of the following items: outcome measure, socket design, energy expenditure, gait, hip joint design, pressure distribution, casting technique, and patient satisfaction.
DISCUSSION AND CONCLUSION High-quality evidence is lacking on the effects of prosthetic components on gait, user satisfaction, prosthetic use, interface pressure, and energy expenditure. Authors mostly evaluated their new design or technique on one or two people with HD or HP amputation. Small sample sizes and insufficient information in the methodology of most articles limited confidence in their findings and generalizability to all patients. New research with vigorous methodology and larger sample sizes is needed to provide strong statistical conclusions.
REFERENCES
Bell CA. Canadian Hip Disarticulation Prothesis. Orthot Prosthet Appliance J. 1956;10:35–9. Ueyama Y, Kubo T, Shibata M. Robotic hip-disarticulation prosthesis: evaluation of prosthetic gaits in a non- amputee individual. Adv Robot. 2020;34(1):37–44. The Hip Disarticulation Prosthesis: Considerations on Rehabilitation.
Rui Brito, Diogo Costa, Raquel Araújo, Sara Afonso, Vasco Marques, Pedro Cantista CHUP, Porto, Portugal
Primary topic
Prosthetics: Lower Limb Transfemoral
BACKGROUND
Hip disarticulation is a rare procedure, usually performed for invasive tumors or other serious conditions for which limb conservation isn’t possible. After disarticulation prosthetic fitting and prolonged rehabilitation are the next steps to improve the quality of life and functionality of these patients. However, despite efforts, only a small percentage of patients are able to walk with the prosthesis.
AIM
This work aims to identify the causes of patient drop-out from prosthesis rehabilitation and analyze the literature on the best rehabilitation approach for these patients.
METHOD
A comprehensive search of the available literature was performed using electronic databases (PubMed and Google Scholar) from origin until the current date. Keywords relevant to the question being studied were chosen (Hip disarticulation, Canadian-type prosthesis, rehabilitation). Boolean operators were used to narrow the search results. All relevant studies concerning rehabilitation after hip disarticulation were retrieved for analysis. Results are presented in a narrative format.
RESULTS
Available data is mostly based on small observational studies. Studies demonstrate that patients can achieve independent ambulation after prosthetization albeit with higher energy expenditure and slower walking speeds. Patients also experience limitations in standing, sitting, and climbing stairs. Trunk stability appears to not differ compared to other types of amputation. A higher degree of fitness seems necessary to achieve successful ambulation. Rehabilitation programs should include cardiovascular training, ROM and strengthening exercises, training in transfers, daily activities, and walking. Socket discomfort, cosmetic reasons, and ambulation difficulties are the most common reasons for patient dropout. Age, body mass index, other comorbidities, and demographics weren't associated with unsuccessful prosthetic fitting. Outcomes appear better for hip disarticulation from tumoral causes than those with vascular and infectious causes. According to a study, juvenile patients can easily master the disarticulation prosthesis and achieve a satisfactory gait.
DISCUSSION AND CONCLUSION
Independent ambulation after hip disarticulation is possible and depends on successful prosthesis fitting and intensive rehabilitation. Current evidence on this subject is limited. However, a program consisting of cardiovascular conditioning, joint mobility, global strengthening, daily activities, and walking training seems to be the basis of a successful rehabilitation program. Attention should be paid to socket revision until maximal comfort is achieved. An individual assessment of each patient’s expectations and goals is also essential to improve outcomes.
Gait State Detection Based on Pelvic Motion of Transfemoral Amputees at Varying Gait Velocities
Farshad Golshan1, Natalie Baddour1, Edward D Lemaire1,2 1Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada. 2Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada
Primary topic
Prosthetics: Lower Limb Transfemoral
BACKGROUND
Motorized prosthetic knee joints have many advantages over conventional prosthetics [1]. Hip prosthetics have yet to benefit from active robotics, partially due to the lack of lower limb movement to be used as a control source [2]. Gait state could be determined using pelvic obliquity angular motion [3]; however, reliance on a single-axis pelvic motion to control motorized hip prosthetic can be unreliable and prone to detection errors. Further research on the pelvic motion for gait state detection is needed.
AIM
To analyze pelvic rotation, tilt, and obliquity of 10 transfemoral amputees and extract common characteristics that can be used to design an intelligent hip prosthesis control system
METHOD
VICON motion-capture from 100 strides (ten strides for ten participants) were selected. 3D pelvic motion (tilt, obliquity, rotation) was extracted and studied separately. Initial foot strike and foot off angles, as well as angular velocity threshold crossing, were the focus since they provided information regarding local minima and maxima of pelvic angular displacement at each major gait state. The extracted points were then compared with hip angle, gait time, and gait velocity to determine correlations.
RESULTS
Four correlations were common among all participants: hip extension and the pelvic tilt angular displacements at max hip extension instance (r = 0.67), hip flexion angle and the pelvic tilt at heel strike (r= 0.85), second threshold crossings of pelvic rotation in relation to the hip angular displacement in that instance (r = 0.49), pelvic rotation angular displacement at the first threshold crossing of the swing phase, inversely correlated to the gait velocity (r= -0.6). The third and fourth correlations improved after removing data from participants 4 and 7 (r= 0.63 and r= -0.82, respectively). The individual analysis demonstrated that the second threshold crossing of pelvic rotation can be used as the reference point for detection of foot flat instance during stance phase (r> 0.7, present for 5 people).
DISCUSSION AND CONCLUSION
Many factors contribute to pelvic motion variability. This study determined that, although measurements of angular velocity threshold crossings can be utilized to extract features common among all participants, a separate analysis of each pelvic motion dimension did not yield more than 85% correlation. However, the combined use of extracted features from all three axes of pelvic motions could provide a reliable gait control system for motorized hip prosthetics.
REFERENCES
1. Brandt, Andrea; 2017, Scientific Reports journal 2. Baum, Brian; 2008, journal of Injury 3. Michaud, Stephanie; 2000, Journal of Rehabilitation Research and Development.
ACKNOWLEDGEMENTS This research has been financially supported by Mitacs. Differences in Self-Reported Mobility in Persons with Lower Limb Amputation Using Either a Microprocessor or Mechanical Knee-Joint
Terje Gjøvaag, Ingrid Iversen Langseth, Mari Bergelien Solberg, Inger Marie Starholm Oslo Metropolitan University, Oslo, Norway
Primary topic
Outcome Measurements
BACKGROUND
Several factors affect the mobility of persons with a lower limb amputation (LLA), and for persons with a transfemoral amputation (TFA), type of prosthetic knee may be an important factor. Wurdeman (2018) showed that TFA with microprocessor knee joints (MPK) had higher self-reported mobility than TFA with non-MPKs, but their study included persons with both dysvascular and non-vascular etiology. Presently, there is little data on how the use of MPK or non-MPK affect self-reported mobility in TFA with non-vascular amputation.
AIM
Investigate the impact of using either a MPK or non-MPK on self-reported mobility of persons with non-vascular TFA
METHOD
Of a cohort of 465 persons in Norway with LLA, a sample of 115 persons (41 females) with non-vascularTFA were included in the present analysis. Self-reported mobility was reported by the 12-item Prosthetic Limb User Survey of Mobility (PLUS-M) (Hafner, 2016). Each item was scored from 1 to 5 (1=unable to do, 5=without any difficulty). In addition, information regarding age at amputation and years as prosthetic user was collected. Pairwise comparison of groups was done by Independent Samples T-test.
RESULTS
Mean (SD) age when amputated for TFA MPK (n=64) and TFA non-MPK (n=51) was similar between groups with 35.5 (19.5) and 31.6 (25.4) years, respectively. Experience as prosthetic user for the different groups were 18.3 (14.2) and 30.9 (21.0) years, respectively (p<0.001). Mean (SD) PLUS-M T-scores for TFA MPK, and TFA non-MPK was 54.7 (9.1), 50.7 (10.3), respectively (p<0.05). The average difference in T scores for MPK and non-MPK users across the different 12-items was 0.373 (95% Confidence Interval 0.040 – 0.707) (Fig 1). DISCUSSION AND CONCLUSION
All participants were amputated at approximately the same age (~30-35 years) and of similar etiology. Mean PLUS- M T scores were significantly higher for TFA MPK compared to non-MPK despite the fact that the non-MPK were sigificantly more experienced prosthetic users. The observed mean difference in T-Score is close to the minimum detectable change of 4.5 (90% CI), hence type of prosthetic knee may be important for over-all mobility of non-vascular TFA, but more research is needed.
REFERENCES
Wurdeman SR, 2018. Assistive Technology 32(5): 236-242. Hafner B, 2016. J Rehabil Res Dev 53(6):797-812 A Systematic Review of Electromyography-Driven Control Algorithms for Lower Limb Prostheses
Bahareh Ahkami1,2, Alexander Thesleff1,2,3, Max Ortiz-Catalan1,2,4,5 1Center for Bionics and Pain Research, Gothenburg, Sweden. 2Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden. 3Integrum AB, Mölndal, Sweden. 4Operational Area 3, Sahlgrenska University Hospital, Gothenburg, Sweden. 5Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Primary topic
Prosthetics: Lower Limb Transfemoral
BACKGROUND
Most amputations occur in the lower limb but despite the availability of musculature in the residual limb and improvements in prosthetic technology, no commercial prosthetic legs use electromyographic (EMG) signals as input for control. Rather, commercially available prosthetic legs are completely passive or rely on information other than neuromuscular for controlling the prosthesis. Nevertheless, research on using EMG signals for lower limb prosthetic control has been conducted by different research groups around the world.
AIM
To provide a systematic review of the state-of-the-art algorithms utilizing EMG for the control of lower limbs.
METHOD
Four different online databases were searched in July 2020: Web of Science, Scopus, PubMed, and Science Direct. The search was conducted with the keywords: prosthetic OR prostheses OR prosthesis OR "artificial limb" AND (("lower limb") OR leg OR ankle OR knee) AND control AND (Electromyography OR EMG OR neural)). Only publications reporting the use of EMG signals from the lower limb for control of a leg prosthesis or for classification of ambulation or non-weight-bearing movement were considered. A total of 130 papers were included and assessed in this review.
RESULTS more than 60 percent of studies included weight-bearing activities and able-bodied participants, with 2-16 electrodes placed over the residual gluteal muscles or residual shank muscles (transfemoral and transtibial amputation, respectively). In studies including individuals with transfemoral amputation, machine-learning- based methods such as linear discriminant analysis or support vector machine were most used for classification of lower limb movements (90 percent). Direct control was most popular in studies with individuals with transtibial amputation (85 percent). For the machine learning control methods, the most common outcome measure was error/accuracy of classification. Large variations were found across studies, for example, different control methodologies, research participants, recording protocols, assessments, and prosthetic hardware.
DISCUSSION AND CONCLUSION
Special consideration was given to studies in which real-time decoding of ambulation modes was performed on research participants with amputation. These papers are important since this condition better reflects home- use of a prosthesis. Machine learning was the most common method for classification. These algorithms are easy to implement and may allow for more degrees of freedom. It is worth noting that there is still a long way to go until stable, robust EMG control is achieved for home-use lower limb prostheses.
ACKNOWLEDGEMENTS
Research supported by Promobilia Foundation, IngaBritt and Arne Lundbergs Foundation, Swedish Innovation Agency (VINNOVA), Swedish Research Council (Vetenskapsrådet).