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PURPOSE The clinical benefits of microprocessor-controlled prosthetic knees (MPKs) in community ambulators have been well-established. A systematic review in limited community ambulators published in 2014 found benefits in safety, performance-based, and patient-reported outcomes. This work updates the previous analysis to the current state of the published evidence. METHODS Systematic review and meta-analysis of the effect of MPKs in limited community ambulators. RESULTS Thirteen research projects presented in 15 publications were identified. Overall validity was "high" in nine studies, "moderate" in three, and "low" in one. The literature described a total of 2366 patients, with 704 classified as limited community ambulators. The use of MPKs in limited community ambulators led to a reduction in falls (SMD g: -0.59; 95% confidence interval (CI) [-0.85, -0.32; I2=0%]), fear of falling (SMD g: 1.2; 95%CI [0.55, 1.85; I2=80%]), risk of falling as indicated by the TUG (SMD g: -0.45, 95%CI [-0.87, -0.02; I2=0%]), an improvement in mobility grade (0.51; 95%CI [0.47,0.55]), self-selected walking speed (SMD g: 0.47; 95%CI [0.14,0.81; I2=0%]), and patient-reported ambulation (MD 9.32; 95%CI [3.61, 15.02; I2=7%]), and utility (MD 7.76; 95%CI [2.05-13.47; I2=0%]). Other outcomes exhibited trends in favor of MPK use or remained insensitive. No outcome was identified favoring non-MPKs. CONCLUSIONS These results suggest that MPKs may be considered a valuable therapeutic option in limited community ambulators with a transfemoral amputation.Implications for rehabilitationAbove knee amputees may be treated with a large variety of artificial exo-prosthetic knee components.Microprocessor-controlled prosthetic knees have proven to be advantageous and cost effective for community ambulators.The current analysis shows similar effects in safety, mobility, and patient perception also for limited community ambulators.Microprocessor-controlled prosthetic knees are a viable therapeutic option for limited community ambulators.

Background Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.

Background: Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes. Objectives: To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees. Study design: Comparative within-subject clinical study. Methods: A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor–enhanced knee. Results: Self-reported falls significantly declined 77% (p = .04), Activities-Specific Balance Confidence scores improved 12 points (p = .005), 2-min walk test walking distance increased 20 m on level (p = .01) and uneven (p = .045) terrain, and patient satisfaction significantly improved (p

Overhead work activities can lead to shoulder pain and serious musculoskeletal disorders (WMSD), such as rotator cuff injury and degeneration. Recently developed exoskeletons show promising results in supporting workers in such activities. In this study, a novel exoskeleton was investigated for two different overhead tasks with twelve participants. To investigate the effects of the device, electromyographic (EMG) signals of different shoulder and adjacent muscles as well as kinematic and metabolic parameters were analyzed with and without the exoskeleton. The mean EMG amplitude of all evaluated muscles was significantly reduced when the exoskeleton was used for the overhead tasks. This was accompanied by a reduction in both heart rate and oxygen rate. The kinematic analysis revealed small changes in the joint positions during the tasks. This study demonstrated the biomechanical and metabolic benefits of an exoskeleton designed to support overhead work activities. The results suggest improved physiological conditions and an unloading effect on the shoulder joint and muscles which are promising indicators that the exoskeleton may be a good solution to reduce shoulder WMSD among workers who carry out overhead tasks on a regular basis.

Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p = .001), paretic limb health (p = .04), sounds (p = .02), and well-being (p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.

INTRODUCTION Long-term damages after lower extremity amputation have previously been analysed in three systematic reviews 5–7 showing that amputees have a higher risk for developing knee and hip osteoarthritis on the sound side. The altered gait pattern appears to increase the load on the sound side.1–3 This paper analysed the extent to which the above described assumption is supported by the scientific literature with specific focus on the risk of developing back pain and osteoarthritis in amputees. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32034/24450 How to cite: Pröbsting E, Kannenberg A, Blumentritt S. BACK PAIN AND OSTEOARTHRITIS AS SECONDARY DISABILITIES OF LOWER LIMB AMPUTATION. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32034 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/

INTRODUCTION Absence or amputation of a lower limb may be the life-altering consequence of congenital deficiency, trauma, malignancy, peripheral vascular disease, diabetic neuropathy, and other conditions. The risk of leg amputation increases with age for all etiologies; however, vascular disease accounts for up to 82 percent of lower-limb amputations [1]. A more proximal amputation results in greater physical and functional impairment to the individual, including a decreased likelihood of regaining household or community ambulation and an increased risk of falling in subjects with above-knee as compared with below-knee amputation [2-13]. According to a consolidation of recent epidemiological studies, the population of people with above-knee limb loss living in the United States may be as large as 400,000 [14-15]. Adequate selection of prosthetic components is one of the key processes to achieving the best possible rehabilitation outcomes. In subjects with transfemoral amputation (TFA), the prosthetic knee is a very important component tasked with restoring knee biomechanics while at the same time providing maximum stability and safety [16-19]. In the early 1990s, Medicare adopted the Medicare Functional Classification Levels (MFCLs), which are used to rate the person with amputation's ability and/or potential ability to ambulate. Shortly thereafter, based on the prosthetic knees available at that time, Medicare developed coverage criteria (indications/limitations and/or medical necessity) for prosthetic knees that were adapted to the MFCL. Medicare's prosthetic knee coverage criterion has not been modified since its inception and remains in effect today (Table 1) [20]. Additionally, the MFCL and coverage criteria have also been adopted by many third-party payors [21]. Fluid stance control mechanisms available at that time were correctly considered too difficult to be safely operated by lower-functioning individuals, and the remaining traditional stance control mechanisms offered similar levels of inherent stability and support of function [16,22]. As a result, the coverage criteria for prosthetic knees were based on the ability and/or potential ability of subjects to vary cadence and walking speed as the decisive criterion for the selection of an appropriate swing control technology. As a consequence of these criteria, fluid control prosthetic knee mechanisms, regardless of their use for stance or swing control, have been reserved for usually younger persons with amputation of the higher MFCL-3 and MFCL-4 mobility grade. In the past 15 yr, prosthetic technology has progressed to microprocessor (MP)-controlled fluid stance as well as stance and swing control mechanisms to overcome the inverse relationship between stability and support of function inherent in non-MP-controlled prosthetic knees (NMPKs). Clinical research, mainly conducted in the unlimited community ambulator (MFCL-3) population with low to moderate methodological quality, has demonstrated improved safety and superior function of MP-controlled prosthetic knees (MPKs) [23] in level walking [24-30], walking on uneven terrain [24-26,31-32], walking on slopes [21,26,33-34], walking on stairs [25,31,35], and stumble recovery [24-25], resulting in significantly reduced numbers of stumbles and falls and improved balance than with NMPKs [24-26,31,34,36]. With current coverage criteria restricting the provision of advanced prosthetic technology to usually younger, healthier, higher-functioning individuals, lowerlimb prosthetics finds itself on a different pathway than other fields of healthcare. Typically, most advanced healthcare technologies serve the oldest, sickest, and most restricted patients, as reflected by the fact that 80 percent of lifetime healthcare expenditures are incurred in the second half of life [37] with a substantial share of these accruing in the last year before death [38-40]. Today, the majority of patients undergoing a TFA are over the age of 65 yr [1,41-43] and do not reach the level of unlimited community ambulation [13] using the prosthetic knees covered under current Medicare criteria, which are simple in technology, limited in function, and often developed decades ago. …

Introduction Unloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle–foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA. Materials and methods Twenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student’s t test. Results Of the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients). Conclusions This observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee. peerReviewed