Ottobock (Austria)

Dysfunction of the central nervous system may inflict spastic movement disorder (SMD). Electrical stimuli were identified as promising therapeutic option. Electrical stimulation provided by a 58-electrode full body garment was investigated based on data from regular trial fittings. Data from 72 testees were investigated. Age averages 36.6 (19.8) ys with 44 females. The cohort spans infantile cerebral paresis (CP) (n=29), multiple sclerosis (MS) (n=23) and stroke (n=20). Data were stratified by etiology and an entry BBS Score<45. Effect sizes (Cohen`s d) related BBS, TUG, FGA, 10mWT, WMFT, EQ5D5L and Pain. Significance levels are indicated by *: p<0.05, **: p<0.01, ***: p<0.001, (t): p<0.1: CP: 1.64***, 0.29*, 1.59***, 0.76(t), 1.00***, 0.5*, 1.28***; MS: 1.83***, 0.83***, 1.28**, 1.07***, 0.93*, 1,11**, 0.78*; Stroke: 1.28**, 0.78**, 0.89, 0.92**, 0.71, 1.26*, 0.78*. Multi-site transcutaneous electrical stimulation may increase ambulation related skills in subjects with SMD stemming from CP, MS and stroke. The results indicate effects on static and dynamic balance, fall risk, mobility, upper extremity improvement and an overall increase in health utility and a reduction in spasticity related pain. Effects are immediate as well as sustained. These results may inspire individual trial fittings and inform further controlled trials.

STUDY DESIGN:Retrospective analysisBACKGROUND:The gait characteristics of transtibial amputees (TTs) have been described many times. In general, the literature reported nearly consistent results for the kinematic and kinetic parameters of the prosthetic side. However, the literature revealed inconsistent findings on kinetic parameters for determining the risk of developing knee osteoarthritis, such as the peak knee adduction moment, knee flexion moment and vertical ground reaction forces.OBJECTIVES:The objective of our study was to describe the sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb and the knee loading parameters of the sound side of unilateral TTs. This specific consideration may contribute to resolving the controversy of these parameters in the literature.METHODS:We analysed our database containing gait analyses from 53 unilateral TTs and compared data to a control group (CG), also taken from our database. The sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb, and selected knee loading parameters of the sound side (the peak knee adduction moment, knee flexion moment and vertical ground reaction forces) were evaluated. Beside these parameters we reported typical spatiotemporal gait parameters as gait velocity, step length, step length asymmetry, stance phase duration and asymmetry of stance phase duration.RESULTS:The TTs walked slower and more asymmetrically than the CG. The kinematic pattern of the prosthetic ankle differed from that found in the CG. The largest difference was observed for the range of motion of the plantarflexion at push-off, which was significantly reduced for the prosthetic foot. The residual knee joint was generally affected with respect to decreased moments and reduced knee flexion during stance phase. The peaks of the vertical ground reaction forces and knee adduction moments showed no differences between the sound side of amputees and the CG. The peak knee flexion moment at midstance was significantly reduced for the sound side of amputees in comparison with the CG.CONCLUSION:The biomechanical data measured for the prosthetic side in a cohort of 53 unilateral TT amputees conformed with the literature. The parameters determining the risk of developing knee osteoarthritis investigated in our retrospective analysis were not increased on the sound side in comparison with non-amputees. We deem it reasonable to assume that an appropriate prosthesis will reduce the likelihood of overloading the knee on the sound side during normal walking.

INTRODUCTION&#x0D; Several years ago, a new microprocessor controlled knee (MPK), Genium, was introduced containing sensors, algorithms and technical solutions that enable a range of new functions to lower limb amputees. We conducted a systematic review to evaluate the effect of the knee on ambulation, mobility, activities of daily living (ADLs) and quality of life (QoL).&#x0D; Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32033/24449&#x0D; How to cite: Mileusnic M, Rettinger L, Highsmith M.J, Hahn A. BENEFITS OF GENIUM MICROPROCESSOR CONTROLLED KNEE ON AMBULATION, MOBILITY, ACTIVITIES OF DAILY LIVING AND QUALITY OF LIFE: A SYSTEMATIC REVIEW. CANADIAN PROSTHETICS &amp; 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.v1i2.32033 &#x0D; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. &#x0D; http://www.aopanet.org/

Stroke is the main cause of permanent and complex long-term disability in adults. RETRAINER S2 is a system able to recover and support person’s ability to perform Activities of Daily Living (ADL) in early stage after stroke. The system is based on exercises for hand and wrist performed using Neuro Muscular Electrical Stimulation (NMES). This work describes the preliminary results of a multi-center Randomized Controlled Trial (RCT) aimed at evaluating effectiveness of the system. The preliminary results were calculated on 18 patients who completed the protocol. Data is promising, the RETRANER S2 system seems to be a good tool for stroke rehabilitation. Data confirms also a general good usability of the system.

Myoelectric prostheses use electromyography (EMG) signals to control the movements of the prosthesis. EMG-signals are electric potentials on the skin which originate from voluntarily contracted muscles within a person’s residual limb. Thus prostheses of this type utilize the residual neuro-muscular system of the human body to control the functions of an electrically powered prosthesis. Standard measurements are done using conductive electrodes on the skin surface. For technical reasons a capacitive coupling of the EMG to the prosthesis control would be preferable. To design optimal settings of the sensors, a detailed knowledge of the temporal electric potential distribution is vital. Here we show the simulation of the EMG using finite elements employing COMSOL based on MRI data. Then a node-based approach in MATLAB was derived and the comparison with the FE-results show that this approach yields excellent results and offers the advantage of high speed computation which allows for optimization of the sensor geometry. The simulation results were verified using measurements on volunteers showing that indeed our model assumptions and simplifications made are valid. The developed nodal analysis model enables fast and simple determination of the optimal prostheses-sensor geometry for the individual amputee.

ABSTRACT Introduction Lower-activity persons with transfemoral amputation experience many comorbidities that limit their ability to satisfactorily use prosthetic knees and safely conduct their life activities. Kenevo is a novel microprocessor-controlled knee designed specifically to accommodate the needs of lower-activity individuals with transfemoral amputation. Materials and Methods A prospective observational study was conducted to collect first clinical experiences with Kenevo. Patient-reported measures were conducted to assess patient safety, mobility on level walking, stairs and ramps, as well as preference. In addition, feedback from certified prosthetists/orthotists was collected regarding fitting process, acclimation, and patient benefits. Results A total of 29 persons with amputation were fitted with Kenevo. Most of them had unilateral amputations and belonged to the K2 mobility group. Fitting the Kenevo resulted in a positive trend in the Locomotor Capabilities Index 5, Prosthetic Limb Users Survey of Mobility, and Houghton scores (p &gt; 0.05). Kenevo use resulted in a significant reduction of wheelchair dependence for many subjects. Most subjects reported improvements in level walking during various speeds and on uneven ground as well as when walking and standing on ramps and traversing stairs. More than two-thirds of the subjects reported reduction in necessary concentration and perceived exertion when walking with Kenevo. Fear of falling was reduced in 50% of the subjects, whereas the number of subjects who never fell increased from 45% to 72% (p = 0.161) and those who never stumbled from 8% to 50% (p = 0.044). Finally, 89% of the subjects preferred Kenevo to their previous fitting. Conclusions First routine fittings of the new Kenevo microprocessor-controlled knee suggest that it offers numerous advantages to lower-activity persons with amputation. Improvements in functional mobility and safety were observed. Of the subjects, 89% preferred Kenevo over their previous knee. Higher-quality research is needed to confirm the conclusions reached in this observational study.

Modern robotic hands/upper limbs may replace multiple degrees of freedom of extremity function. However, their intuitive use requires a high number of control signals, which current man-machine interfaces do not provide. Here, we discuss a broadband control interface that combines targeted muscle reinnervation, implantable multichannel electromyographic sensors, and advanced decoding to address the increasing capabilities of modern robotic limbs. With targeted muscle reinnervation, nerves that have lost their targets due to an amputation are surgically transferred to residual stump muscles to increase the number of intuitive prosthetic control signals. This surgery re-establishes a nerve-muscle connection that is used for sensing nerve activity with myoelectric interfaces. Moreover, the nerve transfer determines neurophysiological effects, such as muscular hyper-reinnervation and cortical reafferentation that can be exploited by the myoelectric interface. Modern implantable multichannel EMG sensors provide signals from which it is possible to disentangle the behavior of single motor neurons. Recent studies have shown that the neural drive to muscles can be decoded from these signals and thereby the user's intention can be reliably estimated. By combining these concepts in chronic implants and embedded electronics, we believe that it is in principle possible to establish a broadband man-machine interface, with specific applications in prosthesis control. This perspective illustrates this concept, based on combining advanced surgical techniques with recording hardware and processing algorithms. Here we describe the scientific evidence for this concept, current state of investigations, challenges, and alternative approaches to improve current prosthetic interfaces.

Most assistive robotic devices are exoskeletons which assist or augment the motion of the limbs and neglect the role of the spinal column in transferring load from the upper body and arms to the legs. In the SPEXOR project we will fill this gap and design a novel spinal exoskeleton to prevent low-back pain in able bodied workers and to support workers with low-back pain in vocational rehabilitation.

ABSTRACTDespite progress in research and media attention on active upper limb prostheses, presently the most common commercial upper limb prosthetic devices are not fundamentally different from solutions offered almost one century ago. Limited information transfer for both control and sensory-motor integration and challenges in socket technology have been major obstacles. By analysing the present state-of-the-art and academic achievements, we provide our opinion on the future of upper limb prostheses. We believe that surgical procedures for muscle reinnervation and osseointegration will become increasingly clinically relevant; muscle electrical signals will remain the main clinical means for prosthetic control; and chronic electrode implants, first in muscles (control), then in nerves (sensory feedback), will become viable clinical solutions. After decades of suspended clinically relevant progress, it is foreseeable that a new generation of upper limb prostheses will enter the market in the near future based on such advances, thereby offering substantial clinical benefit for patients.