Knee Biomechanics of Alternate Stair Ambulation Patterns

Reid, Susan A.; Lynn, Scott K.; Musselman, Reilly; Costigan, Patrick A.

doi:10.1249/mss.0b013e31814538c8

Cited by 59 publications

(59 citation statements)

References 20 publications

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“…The percentage of support (on average, 65%) and swing times were very similar to those measured in the control group, and to literature data collected in healthy adults 23 . In comparison to level walking, the percentage of swing decreased because the stair height (defined according to the standard size of public environment 31 ) was less than stride length. Also, the climbing action requires extra time to perform the major power output needed during the stair performance than during level walking.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Stair Ascent and Descent in Assessing Donor-Site Morbidity Following Osteocutaneous Free Fibula Transfer: A Preliminary Study

Baj

Lovecchio

Bolzoni

et al. 2015

Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 97%

“…In the present study, patients performed the ascent and descent of three standard steps using the step-overstep strategy that requires lower energy cost and allows higher efficiency 31 . All patients were able to perform the task without support (handrail) or assistance.…”

Section: Discussionmentioning

confidence: 99%

Stair Ascent and Descent in Assessing Donor-Site Morbidity Following Osteocutaneous Free Fibula Transfer: A Preliminary Study

Baj

Lovecchio

Bolzoni

et al. 2015

Journal of Oral and Maxillofacial Surgery

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“…In individuals without amputation, during stepto-step stair ascent gait, a large knee extensor moment and power generation are observed in the lead limb but not in the trail limb, indicating that the lead and trail limbs act as working and supporting limbs, respectively [14]. However, this strategy is typically slower than other strategies [2,3,14]. To keep pace with individuals without amputation, some individuals with transfemoral amputation elect to use a skip-step strategy in which the leading intact limb advances two steps and the trailing prosthetic limb follows to the same step (Fig.…”

Section: Introductionmentioning

confidence: 96%

“…This strategy allows the leading intact limb to do the majority of the effort. In individuals without amputation, during stepto-step stair ascent gait, a large knee extensor moment and power generation are observed in the lead limb but not in the trail limb, indicating that the lead and trail limbs act as working and supporting limbs, respectively [14]. However, this strategy is typically slower than other strategies [2,3,14].…”

Section: Introductionmentioning

confidence: 98%

“…This strategy results in approximately three times greater intact limb knee and hip extensor muscle activity than using a step-to-step strategy, placing greater loads on the intact knee and hip [2]. Despite having limitations, step-to-step and skip-step strategies are more commonly used by individuals with transfemoral amputation because they require less prosthetic knee ROM and power than the step-over-step strategy [14].…”

Section: Introductionmentioning

confidence: 99%

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Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?

Whitehead

Wolf

Scoville

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2 1 ) uses flexion/extension resistance to allow step-over-step stair ascent. Questions/Purposes We compared self-selected stair ascent strategies between conventional and X2 1 prosthetic knees, examined between-limb differences, and differentiated stair ascent mechanics between X2 1 users and individuals without amputation. We also determined which factors are associated with differences in knee position during initial contact and swing within X2 1 users. Methods Fourteen individuals with transfemoral amputation participated in stair ascent sessions while using conventional and X2 1 knees. Ten individuals without amputation also completed a stair ascent session. Lowerextremity stair ascent joint angles, moment, and powers and ground reaction forces were calculated using inverse dynamics during self-selected strategy and cadence and controlled cadence using a step-over-step strategy. Results One individual with amputation self-selected a stepover-step strategy while using a conventional knee, while 10 individuals self-selected a step-over-step strategy while using X2 1 knees. Individuals with amputation used greater prosthetic knee flexion during initial contact (32.5°, p = 0.003) and swing (68.2°, p = 0.001) with higher intersubject variability while using X2 1 knees compared to conventional knees (initial contact: 1.6°, swing: 6.2°). The increased prosthetic knee flexion while using X2 1 knees normalized knee kinematics to individuals without amputation during swing (88.4°, p = 0.179) but not during initial contact (65.7°, p = 0.002). Prosthetic knee flexion during initial contact and swing were positively correlated with prosthetic limb hip power during pull-up (r = 0.641, p = 0.046) and push-up/ early swing (r = 0.993, p \ 0.001), respectively. Conclusions Participants with transfemoral amputation were more likely to self-select a step-over-step strategy similar to individuals without amputation while using X2 1 knees than conventional prostheses. Additionally, the increased prosthetic knee flexion used with X2 1 knees placed large power demands on the hip during pull-up and push-up/early swing. A modified strategy that uses less knee flexion can be used to allow step-over-step ascent in individuals with less hip strength. Level of EvidenceLevel II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Characterization of Kinetic and Kinematic Parameters for Wearable Robotics

Solis-Ortega

Dehghani-Sanij

Martinez-Hernandez

2017

Towards Autonomous Robotic Systems

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Abstract. The design process of a wearable robotic device for human assistance requires the characterization of both kinetic and kinematic parameters (KKP) of the human joints. The first step in this process is to extract the KKP from different gait analyses studies. This work is based on the human lower limb considering the following activities of daily living (ADL): walking over ground, stairs ascending/descending, ramp ascending/descending and chair standing up. The usage of different gait analyses in the characterization process, causes the data to have great variations from one study to another. Therefore, the data is graphically represented using Matlab® and Excel® to facilitate its assessment. Finally, the characterization of the KKP performed was proved to be useful in assessing the data reliability by directly comparing all the studies between each other; providing guidelines for the selection of actuator capacities depending on the end application; and highlighting optimization opportunities such as the implementation of agonist-antagonist actuators for particular human joints.

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Knee Biomechanics of Alternate Stair Ambulation Patterns

Abstract: Overall, SBSL during ascent and SBST during descent had the highest loads. These results increase our understanding of alternative stepping patterns and have important clinical (reduction of loading on injured/diseased leg) and rehabilitation implications.

Cited by 59 publications

References 20 publications

Stair Ascent and Descent in Assessing Donor-Site Morbidity Following Osteocutaneous Free Fibula Transfer: A Preliminary Study

Stair Ascent and Descent in Assessing Donor-Site Morbidity Following Osteocutaneous Free Fibula Transfer: A Preliminary Study

Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?

Characterization of Kinetic and Kinematic Parameters for Wearable Robotics

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