Effects of a Powered Knee-Ankle Prosthesis on Amputee Hip Compensations: A Case Series.
Effects of a Powered Knee-Ankle Prosthesis on Amputee Hip Compensations: A Case Series.
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DOI：
10.1109/tnsre.2020.3040260
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Gregg RD
中科院分区：
文献类型：
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作者：
Elery T;Rezazadeh S;Reznick E;Gray L;Gregg RD
经股截肢者步态往往表现出补偿，由于缺乏踝关节推离的权力和控制摆动脚的位置使用被动假肢。动力假体可以恢复这种功能，但其对代偿行为的影响，特别是在剩余髋关节，还没有得到很好的理解。本文通过行走实验研究了三名经股截肢者使用低阻抗动力膝踝关节假体与日常被动假体相比的剩余髋关节补偿。动力假肢在站立期间使用阻抗控制以实现与地面的顺应性交互，使用基于时间的推出控制器来提供高扭矩和功率，并在挥杆期间使用基于相位的轨迹跟踪来为用户提供对脚放置的控制。实验表明，当受试者使用动力踝关节蹬离时，从剩余髋关节向前推进肢体所需的机械拉离动力较少。2/3例受试者的剩余髋关节的总体正功减少，所有受试者的负功减少。此外，所有受试者显示增加步长，增加假体侧的推进冲动，并改善冲动对称性。对于先前在被动假体上表现出这种补偿的受试者，髋关节环绕度得到改善。步态的这些改善，特别是减少残余髋关节动力和工作，有可能减少经股截肢患者的疲劳和过度使用损伤。
Transfemoral amputee gait often exhibits compensations due to the lack of ankle push-off power and control over swing foot position using passive prostheses. Powered prostheses can restore this functionality, but their effects on compensatory behaviors, specifically at the residual hip, are not well understood. This paper investigates residual hip compensations through walking experiments with three transfemoral amputees using a low-impedance powered knee-ankle prosthesis compared to their day-to-day passive prosthesis. The powered prosthesis used impedance control during stance for compliant interaction with the ground, a time-based push-off controller to deliver high torque and power, and phase-based trajectory tracking during swing to provide user control over foot placement. Experiments show that when subjects utilized the powered ankle push-off, less mechanical pull-off power was required from the residual hip to progress the limb forward. Overall positive work at the residual hip was reduced for 2 of 3 subjects, and negative work was reduced for all subjects. Moreover, all subjects displayed increased step length, increased propulsive impulses on the prosthetic side, and improved impulse symmetries. Hip circumduction improved for subjects who had previously exhibited this compensation on their passive prosthesis. These improvements in gait, especially reduced residual hip power and work, have the potential to reduce fatigue and overuse injuries in persons with transfemoral amputation.