Yes / Background Disruptions to the progress of the centre-of-pressure trajectory beneath prosthetic feet have been reported previously. These disruptions reflect how body weight is transferred over the prosthetic limb and are governed by the compliance of the prosthetic foot device and its ability to simulate ankle function. This study investigated whether using an articulating hydraulic ankle attachment attenuates centre-of-pressure trajectory fluctuations under the prosthetic foot compared to a fixed attachment. Methods Twenty active unilateral trans-tibial amputees completed walking trials at their freely-selected, comfortable walking speed using both their habitual foot with either a rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment. Centre-of-pressure displacement and velocity fluctuations beneath the prosthetic foot, prosthetic shank angular velocity during stance, and walking speed were compared between foot conditions. Findings Use of the hydraulic device eliminated or reduced the magnitude of posteriorly directed centre-of-pressure displacements, reduced centre-of-pressure velocity variability across single-support, increased mean forward angular velocity of the shank during early stance, and increased freely chosen comfortable walking speed (P ≤ 0.002). Interpretation The attenuation of centre-of-pressure trajectory fluctuations when using the hydraulic device indicated bodyweight was transferred onto the prosthetic limb in a smoother, less faltering manner which allowed the centre of mass to translate more quickly over the foot.

yes / Background Unilateral trans-tibial amputees have bilaterally reduced toe clearance, and an increased risk of foot contact, while crossing obstacles compared to the able-bodied. While the able-bodied tend to lead with a ‘preferred’ limb it is equivocal whether amputees prefer to lead with the intact or prosthetic limb. This study determined the effects of laterality, compared to side of amputation, on amputees' obstacle crossing performance. To help understand why laterality could affect performance we also assessed knee proprioception for both limbs. Methods Foot placement and toe clearance parameters were recorded while nine amputees crossed obstacles of varying heights leading with both their intact and prosthetic limbs. Joint-position sense was also assessed. Participants self-reported which limb was their preferred (dominant) limb. Findings There were no significant differences in foot placements or toe clearance variability across lead-limb conditions. There were no significant differences in toe clearance between intact and prosthetic lead-limbs (p = 0.28) but toe clearance was significantly higher when amputees led with their preferred compared to non-preferred limb (p = 0.025). There was no difference in joint-position sense between the intact and residual knees (p = 0.34) but joint-position sense tended to be more accurate for the preferred, compared to non-preferred limb (p = 0.08). Interpretation Findings suggest that, despite the mechanical constraints imposed by use of a prosthesis, laterality may be as important in lower-limb amputees as it is in the able bodied. This suggests that amputees should be encouraged to cross obstacles leading with their preferred limb. / Engineering and Physical Sciences Research Council

The ability to successfully negotiate stairs and steps is an important factor for functional independence. While work has been undertaken to understand the biomechanics of gait in lower-limb amputees, little is known about how amputees negotiate stairs and steps. This study aimed to determine the mechanics of landing in unilateral lower-limb amputees when stepping down to a new level. A secondary aim was to assess the effects of using a shank-mounted shock-absorbing device (Tele-Torsion Pylon) on the mechanics of landing. Methods Ten unilateral amputees (five transfemoral and five transtibial) and eight able-bodied controls performed single steps down to a new level (73 and 219 mm). Trials were repeated in amputees with the Tele-Torsion Pylon active and inactive. The mechanics of landing were evaluated by analysing peak limb longitudinal force, maximal limb shortening, lower extremity stiffness, and knee joint angular displacement during the initial contact period, and limb and ankle angle at the instant of ground-contact. Data were collected using a Vicon 3D motion analysis system and two force platforms. Findings Amputees landed on a straightened and near vertical limb. This limb position was maintained in transfemoral amputees, whereas in transtibial amputees knee flexion occurred. As a result lower extremity stiffness was significantly greater in transfemoral amputees compared to transtibial amputees and able-bodied controls (P < 0.001). The Tele-Torsion Pylon had little effect on the mechanics of landing in transtibial amputees, but brought about a reduction in lower extremity stiffness in transfemoral amputees (P < 0.05). Interpretation Amputees used a stepping strategy that ensured the direction of the ground reaction force vector was kept anterior of the knee joint centre. Using a Tele-Torsion Pylon may improve the mechanics of landing during downward stepping in transfemoral amputees.

Over one million amputees are living in the United States with major lower limb loss (Ziegler-Graham et al. 2008). Lower limb amputation leads to the functional loss of the ankle plantar flexor muscles, which are important contributors to body support, forward propulsion, and leg swing initiation during walking (Neptune et al. 2001; Liu et al. 2006). Effective prosthetic component design is essential for successful rehabilitation of amputees to return to an active lifestyle by partially replacing the functional role of the ankle muscles. The series of experimental and computer simulation studies presented in this research showed that design characteristics of energy storage and return prosthetic ankles, specifically the elastic stiffness, significantly influence residual and intact leg ground reaction forces, knee joint moments, and muscle activity, thus affecting muscle output. These findings highlight the importance of proper prosthetic foot stiffness prescription for amputees to assure effective rehabilitation outcomes. The research also showed that the ankle muscles serve to stabilize the body during turning the center of mass. When amputees turn while supported by their prosthetic components, they rely more on gravity to redirect the center of mass than active muscle generation. This mechanism increases the risks of falling and identifies a need for prosthetic components and rehabilitation focused on increasing amputee stability during turning. A proper understanding of the effects of prosthetic components on amputee walking mechanics is critical to decreasing complications and risks that are prevalent among lower-limb amputees. The presented research is an important step towards reaching this goal. / text

Although sitting is a large part of everyday life is the influence of the sitting positions and chair design on pressure and load distribution as well as comfort for transfemoral amputees quite unexplored. The aim of this study was therefore to examine this further. Two transfemorally amputated females (49 and 57 years old) participated in the study. Three positions were examined for each subject; sitting without foot support and sitting with the knee joints flexed 90◦ and 105◦. The pressure inside the socket was measured by two pressure sensors, placed distally and proximally on the posterior wall inside the socket. The lengthwise pressure distribution and the sidewise load distribution between the socket and the underlying material was measured by a pressure mat. In addition to this, the subjects answered a questionnaire regarding the subjective comfort for each position.  The result showed that the pressure underneath the socket were higher distally than proximally without foot support. The pressure transferred proximally as the knee became more flexed. The most even load distribution sidewise was found when the subjects sat with their knees flexed 105 degrees. Sitting with the knees flexed 90◦ was ranked as the most comfortable position. No conclusion could be made regarding the pressure inside of the socket. Additionally, according to this study the level of comfort does not have any clear relation with the sidewise load distribution or the longitudinal pressure distribution. / En stor del av livet spenderas sittandes, men den påverkan som sittposition och stoldesign har på tryckfördelning och komfort för transfemoralt amputerade är ganska outforskat. Studien ämnar därför undersöka detta. Två transfemoralt amputerade kvinnor (49 och 57 år) medverkade i studien. Tre sittpositioner undersöktes för varje testperson; sittande utan fotstöd samt sittande med knäleden i 90◦ respektive 105◦ flexion. Trycket inuti hylsan mättes med hjälp av två trycksensorer, som placerades distalt och proximalt på den bakre hylsväggen. Tryckfördelningen i längsriktningen och lastfördelningen i sidled mellan hylsan och underlaget mättes med en tryckmatta. Förutom detta svarade testpersonerna även på ett frågeformulär angående den subjektiva komforten för varje position. Resultatet visade att trycket under hylsan var högre distalt än proximalt när inget fotstöd användes. Trycket förflyttades proximalt då knät böjdes. Den mest jämna lastfördelningen mellan sidorna påträffades när knät var flekterat 105◦. Enligt frågeformuläret var den mest bekväma positionen den med 90◦ i knäleden. Ingen slutsats kunde göras angående trycket inuit hylsan. Ingen tydlig relation kunde heller inte hittas mellan den subjektiva komforten och tryck- eller lastfördelningen.

An issue of great concern for amputees continues to be lack of proper fit and comfort in their sockets. This lack can often be attributed to changes in the shape of the residual limb that cannot be compensated for by existing prosthetic socket technology. In regions where cost is a prohibitive factor in the replacement of ill-fitting prosthetic sockets, the need for a volume adjustable, and potentially longer lasting, socket design is abundant. This research focuses on designing a volume adjustable lower limb prosthetic socket that accommodates the needs of amputees in underdeveloped countries using collaborative design techniques. Though advocated as a means of accurately identifying and satisfying their needs, including end-users in the design process often adds an additional layer of complexity because of differences in culture, language, or geography among the participants. This research therefore includes a study in which product design techniques were applied to the same volume adjustable socket design problem with a variety of users – typical users, lead users, and new Empathic Lead Users - from different countries, one developed and one developing. To overcome differences among participants, this research includes an alternative strategy to create Empathic Lead Users (ELU) from non-user product design engineers through the use of simulated lead user experiences. As a result of this study, customer needs analysis with ELU helps to identify 95% of traditional and lead user customer needs and 100% more latent needs, and possibly more avenues for product innovations, than interviewing lead or traditional users alone. The concepts generated by all users were also compared. Based on the resulting concepts’ novelty, variety, quality, and quantity, all users were able to satisfactorily complete the concept generation exercises and produced competitive design solutions. Using the concepts generated during this co-design study, a volume adjustable socket was developed. The final socket design, based on the analogous rotational movement of a camera aperture, is pursued through mechanical and subject testing. Early users of the socket liked the design and it has been demonstrated to provide the necessary volume adjustments, but future design iterations to improve its comfort are necessary. / text

The aim of this thesis was to determine the biomechanical adaptations made by active unilateral trans-tibial amputees when they used a prosthesis incorporating a hydraulically-damped, articulating ankle-foot device compared to non-hydraulically attached devices. Kinematic and kinetic data were recorded while participants ambulated over a flat and level surface at their customary walking speeds and at speeds they perceived to be faster and slower using the hydraulic device and their habitual foot. Use of the hydraulic device resulted in increases in self-selected walking speeds with a simultaneous reduction in intact-limb work per meter travelled. Use of the device also attenuated inappropriate fluctuations in the centre-of-pressure trajectory beneath the prosthetic foot and facilitated increased residual-knee loading-response flexion and prosthetic-limb load bearing during stance. These changes occurred despite the hydraulic device absorbing more, and returning less, energy than the participants’ habitual ankle-foot devices. The changes were present across all walking speeds but were greatest at customary walking speeds. The findings suggest that a hydraulic ankle-foot device has mechanical benefits, during overground gait, for active unilateral trans-tibial amputees compared to other attachment methods. The findings also highlight that prosthetic ankle-foot device ‘performance’ can be evaluated using surrogate measures and without modelling an ‘ankle joint’ on the prosthetic limb.

This autoethnographic study is an attempt to humanize the deviant behaviors and bodies of eating disordered and physically disabled persons in Western culture. The narratives included within are from the author’s own personal experiences as a heterosexual, eating disordered, disabled man. The narratives unfold chronologically in ways that explicate the transitions between identities and the onset and acceptance of each. The goal of this study is to unveil aspects of both eating disorders and disabilities as they relate to the locus of attention surrounding individuals that experience them. The researcher argues that the attention a deviant body draws from others may form the deviant body as a spectacle that can be either eagerly sought after, or reluctantly ascribed to, the individual that holds it.

In the United States, the number of major limb amputees is predicted to exceed several million in the coming decades. For those amputees using a prosthesis, their quality of life (QoL) is often modulated by residuum limb problems resultant from its use. Multiple factors preclude quality evidence-based medicine (EBM) research in the field of prosthetics, leading to greater health risk from prosthetic prescription ambiguity. Positive social change is integral to good QoL; studies support administrative healthcare (AHc) as useful to support such, especially in the absence of EBM. This study utilized Veterans Healthcare Administration (VHA) AHc data to discriminate determinants of residual limb skin problem severity (RLSPS), relative to the artificial limb configuration (ALC) used through a retrospective, longitudinal study of a cohort of U.S.Veteran dysvascular amputees. The dataset was derived from multiple archival VHA AHc databases from which 279 Cohort members were identified who underwent amputation surgery during the fiscal year (FY) 2007 were dispensed a prosthesis, and had clinical records through FY 2011. ICD-9-CM and HCPCS codes were used to identify categories of RLSPS and ALC, respectively, with generalized estimating equations modeling to identify likelihood associations of parameters. Derivation of the study cohort dataset was encumbered by data integrity issues and coding system limitations; significant associations were detected for RLSPS with chronic obstructive pulmonary disease, substance use disorder, and major depressive disorder, regardless of the ALC dispensed. The findings support the utility of an amputee-prosthesis AHc database to drive product, policy, and medical decisions toward an improved QoL for this vulnerable population.

amputation, which includes reduced force generation at the knee and ankle, reduced control of the leg, and different mass properties relative to their intact leg. The physical change in the prosthetic leg leads to gait asymmetries that include spatial, temporal, or force differences. This altered gait can lead to an increase in energy consumption and pain due to compensating forces and torques. The asymmetric prosthesis demonstrated in this research aims to find a balance between the different types of asymmetries to provide a gait that is more symmetric and to make it overall easier for an amputee to walk. Previous research has shown that a passive dynamic walker (PDW) with an altered knee location can exhibit a symmetric step length. An asymmetric prosthetic simulator was developed to emulate this PDW with an altered knee location. The prosthetic simulator designed for this research had adjustable knee settings simulating different knee locations. The prosthetic simulator was tested on able-bodied participants with no gait impairments. The kinetic and kinematic data was obtained using a VICON motion capture system and force plates. This research analyzed the kinematic and kinetic data with different knee locations (high, medium, and low) and normal walking. This data was analyzed to find the asymmetries in step length, step time, and ground reaction forces between the different knee settings and normal walking. The study showed that there is symmetry in step lengths for all the cases in overground walking. The knee at the lowest setting was the closest in emulating a normal symmetric step length. The swing times for overground walking showed that the healthy leg swings at almost the same rate in every trial and the leg with the prosthetic simulator can either be symmetric, like the healthy leg or has a higher swing time. Step lengths on the treadmill also showed a similar pattern, and step length of the low knee setting were the closest to the step length of normal walking. The swing times for treadmills did not show a significant trend. Kinetic data from the treadmill study showed that there was force symmetry between the low setting and normal walking cases. In conclusion these results show that a low knee setting in an asymmetric prosthesis may bring about spatial and temporal symmetry in amputee gait. This research is important to demonstrate that asymmetries in amputee gait can be mitigated using a prosthesis with a knee location dissimilar to that of the intact leg. Tradeoffs have to be made to achieve symmetric step length, swing times, or reaction forces. A comprehensive study with more subjects has to be conducted in-order to have a larger sample size to obtain statistically significant data. There is also opportunity to expand this research to observe a wider range of kinetic and kinematic data of the asymmetric prosthesis.