Abstract
Climbing stairs can pose a major challenge for above-knee amputees as a result of compromised motor performance and limitations to prosthetic design. A new, innovative microprocessor-controlled prosthetic knee joint, the Genium, incorporates a function that allows an above-knee amputee to climb stairs step over step. To execute this function, a number of different sensors and complex switching algorithms were integrated into the prosthetic knee joint. The function is intuitive for the user. A biomechanical study was conducted to assess objective gait measurements and calculate joint kinematics and kinetics as subjects ascended stairs. Results demonstrated that climbing stairs step over step is more biomechanically efficient for an amputee using the Genium prosthetic knee than the previously possible conventional method where the extended prosthesis is trailed as the amputee executes one or two steps at a time. There is a natural amount of stress on the residual musculoskeletal system, and it has been shown that the healthy contralateral side supports the movements of the amputated side. The mechanical power that the healthy contralateral knee joint needs to generate during the extension phase is also reduced. Similarly, there is near normal loading of the hip joint on the amputated side.
The authors acknowledge the valuable contribution of Kimberly Walsh, MS, BME (Otto Bock HealthCare, Minneapolis, MN, USA), in the preparation of this article and Dr. Martin Seyr (Otto Bock HealthCare Products, Vienna, Austria) in the assistance in the schematic representation of climbing stairs in six phases.
References
[1] Bae TS, Choi K, Mun M. Level walking and stair climbing gait in above-knee amputees. J Med Eng Technol 2009; 33: 130–135.10.1080/03091900701404043Search in Google Scholar
[2] Bellmann M, Schmalz T, Blumentritt S. Funktionsprinzipien aktueller Mikroprozessor gesteuerter Prothesenkniegelenke [Functional principles of current microprocessor-controlled prosthetic knee joints]. Orthop-Tech 2009; 60: 297–303.Search in Google Scholar
[3] Bellmann M, Schmalz T, Blumentritt S. Comparative biomechanical analysis of current microprocessor-controlled prosthetic knee joints. Arch Phys Med Rehabil 2010; 91: 644–652.10.1016/j.apmr.2009.12.014Search in Google Scholar
[4] Berry D, Olson MD, Larntz K. Perceived stability, function, and satisfaction among transfemoral amputees using microprocessor and non-microprocessor controlled prosthetic knees: a multicenter survey. J Prosthet Orthot 2009; 21: 32–42.10.1097/JPO.0b013e318195b1d1Search in Google Scholar
[5] Blumentritt S, Bellmann M. Potenzielle Sicherheit von aktuellen nicht-mikroprozessor- und mikroprozessorgesteuerten Prothesenkniegelenken [Potential safety of current non-microprocessor and microprocessor-controlled prosthetic knee joints]. Orthop-Tech 2010; 61: 788–799.Search in Google Scholar
[6] Blumentritt S, Schmalz T, Jarasch R. The safety of C-Leg: biomechanical tests. J Prosthet Orthot 2009; 21: 2–15.10.1097/JPO.0b013e318192e96aSearch in Google Scholar
[7] Hafner BJ, Smith DG. Differences in function and safety between Medicare functional classification level-2 and -3 transfemoral amputees and influence of prosthetic knee joint control. J Rehabil Res Dev 2009; 46: 417–434.10.1682/JRRD.2008.01.0007Search in Google Scholar
[8] Hobara H, Kobayashi Y, Naito K, Nakamura, T, Yamazaki N, Nakazawa K. Biomechanical analyses of stair ascent in transfemoral amputees. 13th World Congress of the International Society for Prosthetics and Orthotics. 2010. http://www.confairmed.de/e3470463/e3711669/e19584/cg245277/cg43955/pub_export?lang=eng&itemid=3382&export_format=exportAbstract&ZMS_CHARSET=utf-8&download:int=1&btn=Export. Accessed on August 2011.Search in Google Scholar
[9] Kahle JT, Highsmith MJ, Hubbard SL. Comparison of non-microprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. J Rehabil Res Dev 2008; 45: 1–14.10.1682/JRRD.2007.04.0054Search in Google Scholar
[10] Kastner J, Weber M. Bergabgehen mit Oberschenkelprothesen [Descending slopes with above-knee prostheses]. Orthop-Tech 2006; 57: 612–616.Search in Google Scholar
[11] Kaufmann KR, Iverson B, Padgett D, Brey RH, Levine JA, Joyner MJ. Do microprocessor-controlled knees work better? J Biomechanics 2006; 39: 70.10.1016/S0021-9290(06)83166-0Search in Google Scholar
[12] Kaufmann KR, Levine JA, Brye RH, et al. Gait and balance of transfemoral amputees using passive mechanical and microprocessor controlled prosthetic knees. Gait Posture 2007; 26: 489–493.10.1016/j.gaitpost.2007.07.011Search in Google Scholar PubMed
[13] Nietert M. Das Kniegelenk des Menschen als biomechanisches Problem [The human knee joint as a biomechanical problem]. Biomed Tech 1977; 22: 13–21.10.1515/bmte.1977.22.1-2.13Search in Google Scholar PubMed
[14] Orendurff MS, Segal AD, Klute GK, McDowell ML, Pecoraro P, Czerniecki J. Gait efficiency using the C-Leg. J Rehabil Res Dev 2006; 43: 239–246.10.1682/JRRD.2005.06.0095Search in Google Scholar
[15] Ossur HF. Power Knee – instructions for use. 2011: http://www.ossur.com/lisalib/getfile.aspx?itemid=22242. Accessed on August 2011.Search in Google Scholar
[16] Otto Bock HealthCare Products GmbH. Genium Bionic Prosthetic System – training material for certification course – introduction. Vienna: Otto Bock HealthCare Products GmbH 2011.Search in Google Scholar
[17] Pusch M, Boiten H, Zarling S. Control of a passive prosthetic knee joint with adjustable damping. Patent WO 2007/128299. Nov 15, 2007.Search in Google Scholar
[18] Pusch M, Boiten H, Zarling S. Method for controlling an orthopaedic joint, patent WO 2009/059594 A2. May 14, 2009.Search in Google Scholar
[19] Schmalz T, Blumentritt S, Altenburg B. Biomechanische Analyse des Schrägen- und Treppengehens mit aktuellen Kniepassteilen [Biomechanical analysis of ambulating slopes and stairs with current knee components]. Orthop-Tech 2006; 57: 682–693.Search in Google Scholar
[20] Schmalz T, Blumentritt S, Jarasch R. Biomechanical analysis of stair ambulation in lower limb amputees. Gait Posture 2007; 25: 267–278.10.1016/j.gaitpost.2006.04.008Search in Google Scholar PubMed
[21] Segal AD, Orendurff MS, Klute GK, et al. Kinematic and kinetic comparison of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees. J Rehabil Res Dev 2006; 43: 857–870.10.1682/JRRD.2005.09.0147Search in Google Scholar PubMed
[22] Seymour R, Engbertson B, Kott K, et al. Comparison between C-Leg microprocessor-controlled prosthetic knee and non-microprocessor control prosthetic knees: a preliminary study of energy expenditure, obstacle course performance, and quality of life survey. Prosthet Orthot Int 2007; 31: 51–61.10.1080/03093640600982255Search in Google Scholar PubMed
[23] Wetz HH, Hafkemeyer U, Wühr J, Drerup B. Einfluss des C-Leg-Kniegelenk-Passteiles der Fa. Otto Bock auf die Versorgungsqualität Oberschenkelamputierter [Effect of the Otto Bock C-Leg knee joint component on the fitting quality of transfemoral amputees]. Orthopäde 2005; 34: 298–317.10.1007/s00132-005-0783-zSearch in Google Scholar PubMed
©2012 by Walter de Gruyter Berlin Boston
