RESUMEN
OBJECTIVE: There is a lack of innovation in affordable prosthetic knee joints for children. One significant reason is the absence of technical requirements which consider the foundation of childhood: growth. This study aims to develop and use a modelling tool to determine the technical requirements throughout childhood growth for one prosthetic knee design feature, a swing phase control mechanism (SPCM). METHODS: 3D gait data of 31 able-bodied children across a range of physical maturities were analyzed. For each participant 2 models were created from a validated paediatric able-bodied musculoskeletal model. The model was first linearly scaled, then a corresponding unilateral right knee-disarticulation amputation model produced by removing segments below the knee and replacing with prosthetic componentry. Long established low-cost prosthetic componentry and a novel polycentric knee were implemented. For each participant, inverse dynamics were conducted and the SPCM torque requirements defined. RESULTS: Prosthetic knee SPCM torque requirements were significantly less than the able-bodied knee to emulate able-bodied gait at free speed: 17.9% (± 10.2) and 66.3% (± 17.0) reduction in maximum extension and flexion torque, respectively. Maximum knee extension torque showed the strongest negative correlation with intact body mass (ρ = -0.6251) whereas flexion torque showed the strongest correlation with height (ρ = 0.6611). Corresponding linear regression fits produced RMSE of 1.91and 1.73 Nm, respectively. Results were also determined for slow and fast speeds. CONCLUSION: The torque requirements of an affordable paediatric prosthetic knee SPCM are defined and found to strongly correlate with parameters of childhood growth (body mass, height, and age). SIGNIFICANCE: Current results recommend low-cost paediatric prosthetic SPCM designs can be tailored to accommodate growth. The creation of musculoskeletal models facilitate multiple future studies.
RESUMEN
Amputation of a major limb, and the subsequent return to movement with a prosthesis, requires the development of compensatory strategies to account for the loss. Such strategies, over time, lead to regional muscle atrophy and hypertrophy through chronic under or overuse of muscles compared to uninjured individuals. The aim of this study was to quantify the lower limb muscle parameters of persons with transtibial and transfemoral amputations using high resolution MRI to ascertain muscle volume and to determine regression equations for predicting muscle volume using femur- and tibia-length, pelvic-width, height, and mass. Twelve persons with limb loss participated in this study and their data were compared to six matched control subjects. Subjects with unilateral transtibial amputation showed whole-limb muscle volume loss in the residual-limb, whereas minor volume changes in the intact limb were found, providing evidence for a compensation strategy that is dominated by the intact-limb. Subjects with bilateral-transfemoral amputations showed significant muscle volume increases in the short adductor muscles with an insertion not affected by the amputation, the hip flexors, and the gluteus medius, and significant volume decreases in the longer adductor muscles, rectus femoris, and hamstrings. This study presents a benchmark measure of muscle volume discrepancies in persons with limb-loss, and can be used to understand the compensation strategies of persons with limb-loss and the impact on muscle volume, thus enabling the development of optimised intervention protocols, conditioning therapies, surgical techniques, and prosthetic devices that promote and enhance functional capability within the population of persons with limb loss.