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Introduction: In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic-and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods: Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results: A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion: The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion:The results show varying benefits of the microprocessor-and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes. (

Introduction Microprocessor ankles (MPAs) have recently been developed for persons with lower-limb amputation to overcome known limitations of fixed-ankle energy-storing-and-returning (ESAR) feet. This study aimed to examine differences in patient-reported balance, mobility, socket comfort, and preference between an ESAR foot and an MPA in persons with unilateral transtibial amputation (UTA). Materials and Methods Twenty-three participants with UTA enrolled in an institutional review board–approved, randomized crossover protocol with ESAR (Pacifica LP) and microprocessor-ankle configurations (Kinnex, Freedom Innovations) and a 4-week accommodation period. The outcome measures collected included Activities Specific Balance Confidence Scale (ABC), Prosthesis Evaluation Questionnaire–Mobility Subscale (PEQ-MS), and Prosthetic Limb User Survey of Mobility (PLUS-M). Participants were asked to rate Socket Comfort Score (SCS) while ascending and descending a 15° sloped ramp. Finally, ankle-foot preference and aspects liked and disliked about each configuration were recorded. Results Significant improvements were seen with the MPA in patient-reported mobility in the community (PEQ-MS, ρ = 0.0465) and socket comfort walking and standing on slopes (SCS, ρ < 0.001). Differences in balance confidence (ABC) did not reach a level of significance, whereas improvement in perceived mobility with a prosthesis approached a level of significance (PLUS-M, ρ = 0.102). When asked, 81% of participants preferred the MPA over the ESAR foot. Participants reported positively about the reduced weight of the ESAR foot, whereas they frequently reported that the MPA was better on slopes and uneven terrain. Conclusions The 30° range of motion in the MPA can allow greater mobility when ambulating on typical environmental barriers (e.g., uneven terrain, ramps, and stairs) and allow patients to stand and walk on slopes with less socket discomfort. Most participants preferred the MPA. Frequently reported positive and negative aspects of both systems may be useful for patient consultation regarding ankle-foot technology. This study represents the largest known investigation of MPAs, and the results provide evidence of benefits from MPAs over ESAR feet in persons with UTA.

This study is a retrospective chart review of standardized outcome measure data assessing mobility in persons with lower-limb loss. Patient charts were reviewed after the recent adoption of outcome measures as standard practice at a multiregion prosthetic practice. The study investigated the effects of amputation level and assigned activity level (K-level) on patientperceived potential for mobility and functional ambulatory potential. The Amputee Mobility Predictor (AMP) and Prosthesis Evaluation QuestionnaireYMobility Subscale (PEQ-MS) scores were obtained and compared between transtibial and transfemoral patients and stratified by K-level. An analysis of variance (ANOVA) of AMP and PEQ-MS scores yielded significant variation (a = 0.05) for amputation K-levels. A Fisher protected least significant difference post hoc test found that the K3 and K4 groups had significantly higher AMP with prosthesis (AMPPRO) and PEQ-MS scores than those of the K2 group. The AMP and PEQ-MS scores were not found to be significantly different among transtibial and transfemoral amputation levels in the population studied. These two outcome measures have shown promise for differentiating K-level when adopted as standard practice in the clinical setting. (J Prosthet Orthot. 2014;26:70Y76.)