Transfemoralor above-the-knee amputees face discomfort in their prothesis primarily due to irregular distribution of pressure and shear forces in the Socket-stump interface (SSI). To quantify this discomfort it is necessary to first determine the pressure distribution in the SSI using sensors. However, knowledge of how sensors should be deployed is necessary to support the testing of said pressure on a test-rig or amputee. Previous methods used to determine sensor placement include discretization of the SSI into several regions or the use of a reiterative method based on pressure readings from sensors to determine the optimal placement of sensors. The former fails to identify high regions of pressure as the regions covered by the sensors may not have high pressure whereas the latter is time consuming and may cause further trauma to amputees as it requires repeated experimentation. With the advances in pressure sensor technologies, biomechanical simulations, and Finite elementanalysis(FEA)simulations it is now increasingly possible to determine an accurate estimate of dynamic pressure distribution occurring in the SSI during the gait cycle. The thesis investigates the dynamic pressure distribution in the SSI and determines an effective method of locating the optimal positions for the sensors using two different algorithms. The first is a Genetic Algorithm whereas the second is Pattern Search. / Transfemorala eller amputerade över knäet möter obehag i sin protes främst på grund av oregelbunden fördelning av tryck och skjuvkrafter i SSI. För att kvantifiera detta obehag är det nödvändigt att först bestämma tryckfördelningen i SSI med hjälp av sensorer. Men kunskap om hur sensorer ska distribueras är nödvändig för att stödja testningen av nämnda tryck på en testrigg eller amputerad. Tidigare metoder som använts för att bestämma sensorplacering inkluderar diskretisering av SSI i flera regioner eller användning av en upprepad metod baserad på tryckavläsningar från sensorer för att bestämma den optimala placeringen av sensorer. Den förstnämnda misslyckas med att identifiera höga tryckregioner eftersom den områden som täcks av sensorerna kanske inte har högt tryck medan de senare är tidskrävande och kan orsaka ytterligare trauma för amputerade eftersom det kräver upprepade experiment. Med framstegen inom trycksensorteknologier, biomekaniska simuleringar och FEA-simuleringar är det nu alltmer möjligt att bestämma en exakt uppskattning av dynamisk tryckfördelning i SSI under gångcykeln. Avhandlingen undersöker den dynamiska tryckfördelningen i SSI och bestämmer en effektiv metod för att lokalisera de optimala positionerna för sensorerna med hjälp av två olika algoritmer. Den första är en genetisk algoritm medan den andra är mönstresökning

Diploma thesis "Effect of gait school with prosthesis on stability and walking parameters of patients after transfemoral amputation deals with problems of patients after transfemoral amputation due to vascular etiology. It mentions elementary knowledge of rehabilitation after amputation of lower extremity. Furthermore, there are described main complications that amputation brings into the patient ́s life: pain associated with amputation, skin complications and psychological hardships. Emphasis is laid on gait and gait practice for patients with amputation. I further deal with deviations commonly observed on gait of these patients and with factors influencing the gait, including the influence of particular parts of the prosthesis on patients ́ gait. The practical part is dedicated to comparison of two different approaches to gait practice. The effect of these approaches is evaluated on the basis of results of two groups of patients. The results were gathered by examination on force plate, measurement of gait velocity, examination of gait cadence and evaluation of patients ́s gait videos. Furthermore, I use functional tests: LCI - 5, ABIS - R, ABC scale and PEQ. All of these examinations were performed at the beginning and in the end of patients ́ stay at the Clinic of rehabilitation in Hradec Králové. The...

We have designed and examined a compliant knee mechanism that may offer solutions to problems that exist for infants and toddlers who are just learning to walk. Pediatric prosthetic knees on the market today are not well designed for infants and toddlers for various reasons. Children at this age need a prosthetic that is light in weight, durable, and stable during stance. Of the eleven knees on the market for children, all but three are polycentric or four-bar knees, meaning they have multiple points of movement. Polycentric knees are popular designs because they offer the added benefit of stable stance control and increased toe clearance, unfortunately this type of knee is often too heavy for young children to wear comfortably and is not well suited for harsh environments such as sand or water, common places children like to play. The remaining three knees do not offer a stance control feature and are equally vulnerable to harsh environments due to ball bearing hinges. Compliant mechanisms offer several design advantages that may make them suitable in pediatric prosthetic knees -- light weight, less susceptible to harsh environments, polycentric capable, low part count, etc. Unfortunately, they present new challenges that must be dealt with individually. For example compliant mechanisms are typically not well suited in applications that need adjustability. This problem was solved by mixing compliant mechanism design with traditional mechanism design methods. This paper presents a preliminary design concept for a compliant pediatric prosthetic knee. The carbon fiber composite spring steel design was first built and then evaluated using Finite Element Analysis. The prototype's instant center was plotted using the graphical method. From our analysis position, force and stress information was gathered for a deflection up to 120 degrees. The instant centers that were plotted indicate that the knee has good potential in offering adequate stability during stance.

The subject of this dissertation was the creation of the adapted exercise program for unilateral transfemoral amputees and its verification in practice. The content of this program was chosen based on the practical experience and theoretical background in the field of anatomy, kinesiology, rehabilitation, lower- limb amputations and Motion Capture technologies. The four-month intervention program was designed as an adapted corrective exercise aimed at the major muscle groups influencing the posture, especially the position of the pelvic segment, which is the dominant element in the kinematic chain. The aim of this project was to ascertain whether this intervention can affect the pelvic tilt (in frontal and sagittal plane) of unilateral transfemoral amputees and so improve their quality of life. This was a project based on combination of quantitative and qualitative research methods. The measurement of the size of angles determining the pelvic tilt by Qualisys optoelectronic system was the essence of the quantitative part of the research. Qualitative data were collected through semi-structured in-depth interviews from persons who completed whole project. This research is by its nature and focus characterized as a set of case reports and as a pilot study, proof of concept respectively. 10 unilateral...

Background: Meeting the prosthetists needs, and barriers is important to successful implement evidence into practice. Thus, several implementation methods have been initiated, the authors saw a need to create a Communication Tool based on evidence from transfemoral socket designs, to ease the process of assisting prosthetists in facilitating evidential reasoning.   Aim: To investigate if a Communication Tool can facilitate the usage of evidence into practice by assisting the clinical decision making.  Method: The study is divided into two parts. First the development of the Communication Tool, which is based on the Knowledge to Action model plus an update of studies from a systematic review by Brodie et al.2021. The second part consists of a qualitative pilot-study using semi-structured synchronously interviews to collect data from two Danish working prosthetists. For the analysis a conventional content analysis with an inductive approach was used.  Findings: Findings from the analysis of the interviews compiled eight categories and twenty-five sub-categories covering three key themes identified during the creation of the Communication Tool: Barriers, internal usability, and external usability of the Communication Tool.   Conclusion: The Communication Tool showed to be an effective method to assist and facilitate evidence-based reasonings. The participants found the tool to be useful and appraised positively regarding communicating relevant content an easy to navigate in. Minor improvements are needed, which are related to the quality assessment system and the system of reference as well as some linguistic formulations.

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L’objectif de ce travail de thèse est de caractériser, chez les amputés unilatéraux du membre inférieur, les modalités posturales qui interviennent dans la régulation de l’équilibre orthostatique et d’étudier l’impact de l’amputation sur la production de force à la cheville physiologique. Une première étude a révélé la présence de trois modalités posturales afin de réguler le contrôle postural : les amputés transfémoraux adoptent une modalité posturale basée sur les paramètres de stabilité, les amputés transtibiaux optent pour une modalité posturale mixte et les non amputés se réfèrent aux paramètres de l’attitude posturale. Etant donné que l’articulation de la cheville joue un rôle essentiel dans la régulation de l’équilibre postural, il était alors pertinent d’investiguer la production de force à la cheville physiologique. Toutefois, les ergomètres permettant d’étudier l’articulation de la cheville présentent des biais de mesure majeurs. Dans ce cadre, une deuxième étude a été menée afin de développer et valider un nouvel ergomètre pour cheville : le B.O.T.T.E. Parallèlement, la mise en place d’une méthode de mesure basée sur le retour visuel permettant une quantification fiable du couple de force a fait l’objet d’une troisième étude. Ensuite, une quatrième étude visait à utiliser le B.O.T.T.E. pour investiguer l’impact de l’amputation sur la production de force à la cheville physiologique. Les résultats de cette étude confirment la présence d’un déficit au niveau du couple de force généré en flexion plantaire (conditions maximale et sous maximale) chez les amputés transfémoraux. Enfin, ce travail de thèse vise à aider les rééducateurs et les cliniciens à optimiser la prise en charge des patients amputés. / This Ph.D. thesis aims to evaluate the standing posture modalities and the ankle joint torque in the intact limb in unilateral lower limb amputees. A first study shows the presence of three posture modalities: the non-amputee group relied on standing erect, the transfemoral amputees’ stance depended on balance control and the transtibial amputees exhibited a mixed modality of simultaneously maintaining an upright stance and standing balance. Since the ankle muscles have a functional importance in standing posture modalities, it is imperative to investigate the ankle joint torque in the intact limb. However, the current devices used to assess the ankle joint present substantial limitations for the measurement. Thus, a second study was designed to develop and to validate a new ankle ergometer B.O.T.T.E. Moreover, a third study was achieved in order to estimate the effect of visual feedback on enhancing isometric maximal voluntary contractions. A fourth study was realized to investigate the ankle joint torque in the intact leg of unilateral lower limb amputees. The results show that transfemoral amputees produce less torque and are less steady compared to transtibial amputees and able-bodied individuals. Overall, the present findings of this Ph.D. thesis could have implications for clinical practice and for rehabilitation of patients with a lower limb amputation.

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