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Frossard, Laurent A. (2009) Functional outcome and usage of the prosthesis of lower limb amputees fitted with osseointegrated fixation. In: ISPO2009 : Enhancing Mobility through Therapy and Technology : 32nd Annual Scientific Meeting of the International Society for Prosthetics and Orthotics, Australian National Member Society , 12-14 November, 2009, Surfers Paradise, Australia .

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Functional outcome and usage of the prosthesis of lower limb amputees fitted with osseointegration fixation

FUNCTIONAL OUTCOME AND USAGE OF THE PROSTHESIS OF LOWER LIMB AMPUTEES FITTED WITH

OSSEOINTEGRATED FIXATION Frossard, L1,2

The University of Queensland1, Queensland University of Technology2 (Abstract of invited address: Frossard L. Functional outcome and usage of the prosthesis of lower limb amputees fitted with osseointegration fixation. 2009. 32nd Annual Scientific Meeting of the International Society for Prosthetics and Orthotics, Australian National Member Society - Surfers Paradise, Australia – p 21-24)

INTRODUCTION Assessments of functional

outcome and usage of prosthesis during activities of daily living (ADL) of lower limb amputees has gained increasing importance to support evidence-based practice (e.g., issue of under- and over-prescription of prosthetic components) (Miller, 2006).

In most cases, the capacity to undertake ADL is assessed after or during the fitting of the prosthesis using standardised instruments such as self-reports and physical tasks (Gailey, 2006).

Both types of instruments are easy to administer in clinical settings and require little resources while providing a simple scoring system. However, predictive ability of these instruments of true functional outcome is limited (Figure 1).

Alternatively, functional outcome can be assessed after fitting of the prosthesis using physical measurements during real world ADL.

More recently, a portable kinetic system, based on a transducer and data logger, was introduced for the continuous recording of the true load regime (i.e., frequency and magnitude of overall loading) applied on the residuum of a transfemoral amputee during ADL (Frossard, 2008).

This study presented only the recording of the raw data and some overall performance indicators of the usage of the prosthesis. However, the opportunities to use this load regime data to assess the true ambulatory capacity are yet to be fully explored, although the categorisation of the load regime data is suitable to assess the true functional outcome and usage of the prosthesis of lower limb amputees.

The objectives of this presentation are: • To introduce a categorisation of

load regime based on four activities (i.e., directional locomotion, localised locomotion, stationary loading and inactivity),

• To present some descriptors of each activity, and,

• To report the outcomes for a case study.

METHOD Participant: One fully rehabilitated and active male (33 yr, 1.70 m, 85 kg) fitted with an osseointegrated fixation was asked to participate (Hagberg, 2009; Pitkin, 2009). Apparatus: The prosthesis included a Rotasafe, a transducer, the participant’s usual knee (Otto-Bock 3R80) and foot (Otto-Bock 1D10) fitted with hard running shoes. The portable kinetic system included a six-channel transducer (Model 45E15A;

2009 ISPO, Australian National Member Society Page 1 of 3


JR3 Inc, Woodland, CA, USA) mounted between the Rotasafe and the knee, as well as a data logger (Valitec AD128, Daytona, Ohio, USA), connected to the transducer by a serial cable and carried in a waist pack. The forces and moments were recorded with a sampling frequency of 10 Hz. Procedures: The recording started shortly after 1:30 pm and lasted until 6:30 pm, giving a continuous recording of approximately five hours of the recreational afternoon. Data Analysis: The load was divided into four categories of activities: directional locomotion, localised locomotion, stationary loading and inactivity. Each category was characterised by general descriptors (eg. number of occurrences), loading characteristics (eg. median, minimum and maximum of the magnitude of the load) and the impulse of the forces. Gait cycles were subjected to complementary analysis.

RESULTS The directional locomotion,

localised locomotion and stationary loading corresponded to 44%, 34% and 22% of the occurrences as well as 51%, 38% and 12% of the duration of the periods of activity, respectively. The absolute maximum force during directional locomotion, localised locomotion and stationary loading represented 19%, 15% and 8% of the body weight on the antero-posterior axis, 20%, 19% and 12% on the medio-lateral axis as well as 121%, 106% and 99% on the long axis. A total of 2,783 gait cycles were recorded.

DISCUSSION This study demonstrated that

the proposed categorisation of ADL has the potential to provide a more comprehensive assessment than current instruments mainly because the

measurements were not limited to directional locomotion. In this case, this enabled the detection of approximately 10% more gait cycles that were unlikely to be registered by conventional pedometers. Furthermore, it enabled the measurement of approximately 50% more of the total impulse, occurring during localised locomotion, stationary loading and inactivity, that would have been difficult to estimate using conventional analysis.

However, the apparatus is more resource intensive than the conventional instruments. Consequently, its systematic implementation in clinical settings is somewhat unrealistic. One can argue that this type of assessment will be best used as a complement rather than a replacement of conventional instruments. It might be particularly relevant for difficult cases.

CONCLUSION This study established that the

core principle underlying categorisation of activities have the potential to provide more comprehensive outcomes than the recognition of activities because it takes into consideration activities other than directional locomotion.

REFERENCES Gailey RS. JPO 18(6):51-60, 2006. Miller L, JPO 18(6):2-7, 2006. Frossard L, P & O Ial 32(1):68-78, 2008. Hagberg, K. JRRD 43(3):331-344, 2009. Pitkin M. JRRD. 46(3):3456-360, 2009.



Figure 1. Overview of resources (e.g., time, cost, equipment, space, etc) and comprehensiveness of the output (e.g., range, realism, accuracy, degrees of freedom, etc) of the current and proposed instruments used to assess the functional outcome and usage of prosthesis during ADL.


Laurent Frossard (PhD)

Functional outcome and usage of the prosthesis of lower limb amputees fitted with

osseointegrated fixation

ISPO 2009 - Gold Coast, Australia – 12/11/2009

The University of Queensland, Australia

Queensland University of Technology, Australia

IntroductionBackground

<

Under-prescribed

>

Over-prescribed

=

“Fair”

Usage of prosthesis

Assessments of functional outcome

Activities of daily living (ADL)

Fitting of prosthesis -> components

IntroductionBackground

e.g., time, cost, equipment, space,

etc

e.g., range, realism, accuracy, degrees of freedom, etc

Introduction

Surrogate

Background

• Amputee Activity Survey • Prosthetic Profile of the Amputee • LCI • Russek’s code • PEQ • Orthotic Prosthetic Users • Q-PTA • SIGMA

Introduction

Surrogate

Background

• Two-minute walk• Six-minute walk• Functional Ambulation Profile• Timed Get-Up and Go• Amputee Mobility Predictor

Introduction

Experimental

Surrogate

Background

Introduction

Experimental

Surrogate

Background

• Simple score• Standardised:

Intra-patientInter-patient

Introduction

Experimental

Surrogate

Background

ADL

Step activity monitor

Patient activity monitor

Introduction

Experimental

Surrogate

ADL

Background

Need

Apparatus

providing

comprehensive

information about

the functional

outcome and

usage of the

prosthesis during

activities of daily

living

Introduction

Experimental

Surrogate

ADL

Background

Need

Purposes

Apparatus

providing

comprehensive

information about

the functional

outcome and

usage of the

prosthesis during

activities of daily

living

Frossard et al.. 2008. Prosthetics and Orthotics International. 32 (1). p 68-78

Frossard et al. 2006. Kinesitherapie Revue. 6 (56-57). p 53-62

Frossard et al. 2003. Journal of Prosthetics and Orthotics. 15 (4). p 135-142

Introduction

Experimental

Surrogate

ADL

Background

Need

Purposes

• To determine the relevance of the

categorization

• Objectives:

Introduce a categorization

Present some descriptors

Report the results for a small group

MethodsParticipants • 4 active transfemoral amputees

• Fitted with osseointegrated fixation

MethodsParticipants • 4 active transfemoral amputees

• Fitted with osseointegrated fixation

• Fully rehabilitated

• F in the SIGAM = K4

Methods

Apparatus

Participants

Transducer

Data logger

Rotasafe

Hydraulic Knee

Foot

Methods

Procedure

Apparatus

Participants • Recreational afternoon• 5 hrs of recording (1:30 pm -6:30 pm)

Methods

Procedure

Apparatus

Data processing

Participants • Matlab program (Stevenson, N)

Methods

Procedure

Apparatus

Data processing

Participants

Analysis of gait cycles

• Matlab program (Stevenson, N)

Methods

Procedure

Apparatus

Data processing

Participants • Matlab program (Stevenson, N)

ResultsRaw

Frossard et al.. 2008. Prosthetics and Orthotics International. 32 (1). p 68-78

Inactivity Directional locomotionLocalised

locomotionStationary

loading

Results

Overall usage

Raw

Results

Loading profile

Overall usage

Raw

Results

Loading profile

Overall usage

Raw

50% of BW

Results

Loading profile

Overall usage

Load endurance

Raw

Results

Loading profile

Overall usage

Load endurance

Loading limits

Raw

Results

Loading profile

Overall usage

Load endurance

Loading limits

Impulse

RawCan not be

estimated by conventional gait lab data!

Results

Loading profile

Overall usage

Load endurance

Loading limits

Impulse

Gait analysis

Raw • Gait cycles = 2,783:

90% Directional locomotion

10% Localised locomotion

• Cadence:

10 stride/min = Overall

47 stride/min = directional locomotion

• Duration gait cycles = 1.26±0.16 s:

46% = swing

54% = support

Results

Loading profile

Overall usage

Load endurance

Loading limits

Impulse

Gait analysis

Variability

Raw

Inter-variability

Intra-variability

HighRecording

LowFitting

Confounders

• Duration• Employment• Weather• Environment• Mood• Etc...

Bias toward rest !!!

ConclusionsLimitations • Only 10 Hz

• Limited population

• No complementary information

Kinematics

Activity

Conclusions

Future studies

Limitations • Longitudinal:

Intra-variability

Inter-variability

• Cross-sectional:

Categorization vs. self-reports

E.g., SIGMA

Categorization vs. physical tasks

E.g., Six-minute walk

Categorization vs. instruments

E.g., Pedometers

Conclusions

Contributions

Future studies

Limitations • Demonstrated participants level of:

Activity

Comfort

E.g., 50% BW during stationary load

• Proposed a categorization

Localised activities

E.g., 10% more gait cycles

E.g., 11% impulse

Conclusions

Contributions

Future studies

Limitations

Conclusions

Contributions

Future studies

Limitations

More comprehensive

outcomes

More resources intensive

Complementary of other

conventional instruments

Differentiate difficult patients !!!

AcknowledgementsNathan Stevenson Eva Häggström

Team,

ISPO 2004

Hong-Kong

Team,

ISPO 2007

Vancouver

John Sullivan

Questions ?

Now !

or

Later

[email protected]

[email protected]

mailto:[email protected]:[email protected]

Laurent Frossard (PhD)

Functional outcome and usage of the prosthesis of lower limb amputees fitted with

osseointegrated fixation

ISPO 2009 - Gold Coast, Australia – 12/11/2009

The University of Queensland, Australia

Queensland University of Technology, Australia

ISPO2009-Abstract-ePrint-01.pdf(Abstract of invited address: Frossard L. Functional outcome and usage of the prosthesis of lower limb amputees fitted with osseointegration fixation. 2009. 32nd Annual Scientific Meeting of the International Society for Prosthetics and Orthotics, Australian National Member Society - Surfers Paradise, Australia – p 21-24)INTRODUCTION METHODRESULTSDISCUSSIONCONCLUSIONREFERENCES

2009 ISPO-Gold Coast-Categorisation ADL-01Slide Number 1IntroductionIntroductionIntroductionIntroductionIntroductionIntroductionIntroductionIntroductionIntroductionIntroductionMethodsMethodsMethodsMethodsMethodsMethodsMethodsMethodsMethodsResultsResultsResultsResultsResultsResultsResultsResultsResultsResultsConclusionsConclusionsConclusionsConclusionsConclusionsConclusionsAcknowledgementsQuestions ?Slide Number 39

qut digital repository: //eprints.qut.edu.au/28680/2/28680.pdf · 2010. 6. 9. · functional...

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