下肢假肢零部件选择与轻量化

下肢假肢的轻量化问题主要涉及到零部件的重量、性能和截肢的活动性（度）等方面。内论述了截肢的状况、零部件的性能、重量和合理选择三之间的关系，通过对近、现代下肢假肢零部件的发展状况的回顾，从下肢假肢零部件在截肢中实际选择、运用等角度分析了三之间的关系。     

低成本下肢假肢的开发与为残疾人服务的实践

1背景据统计 ,我国现有肢体残疾人 877万人 ,其中截肢者 90万 ,上肢截肢者 2 6万人 ,下肢截肢者 6 4万人。由于种种原因 ,下肢截肢者约有 2 3万人尚未安装假肢 ,其中未安装小腿假肢者约 13万 ,未安装大腿假肢者约 10万。他们中间有的靠双拐渡过人生 ;有的双小腿截肢者靠膝盖爬行 ;有的单小腿截肢者利用竹筒、木料、钢筋等材料自制小腿假肢 ,艰难行走。这些缺肢者大多生活在农村和基层 ,由于丧失劳动能力 ,个人生存艰难、家庭生活贫困。截肢者至今未能安装下肢假肢的原因大致有 :1.1资源远离缺肢者　现有假肢安装机构和技术人员大多集中在省…     

碳纤维复合材料特性及在假肢领域的应用

假肢的质量对下肢截肢患者运动所消耗的能量有直接的影响,因此,在实际为患者装配选择假肢零部件时,应在充分考虑满足患者要求功能的前提下,尽可能选择质量轻的下肢配件.基于上述原因,一些强度高、质量轻的材料,如钛合金、超轻铝合金、碳纤维复合材料等,在设计与制造下肢假肢零部件时被广泛使用,使现代假肢功能更完善、质量更轻.其中,与前两种材料相比,碳纤维复合材料在假肢领域的开发和应用相对较晚.文章对碳纤维复合材料的特性进行综述,并重点介绍了近10年来碳纤维复合材料在下肢假肢领域中的应用,包括碳纤维假脚、踝关节、膝关节以及接受腔等.最后,对中国假肢领域需进一步研究的问题进行了初步探讨.     

一种动力型髋离断假肢控制系统研究

目的 探讨一种动力型髋离断假肢控制方法提升佩戴者步态对称性的可行性。 方法 通过九轴姿态传感器采集健康人体下肢步态运动学信息,使用BP神经网络建立穿戴髋离断假肢截肢者健侧-假肢侧运动学映射模型。将截肢者健侧腿的运动学信息实时传入该映射模型,生成髋离断假肢运动的目标轨迹,结合下肢假肢动力学模型,通过PID算法控制髋离断假肢电机运动,实现截肢者的实时步态分析和假肢的实时控制。记录截肢者穿戴动力髋离断假肢行走实验中的步长、步频及最大髋关节角度等数据,并结合步态对称性指标SⅠ、RⅠ、RⅡ对假肢控制效果进行评估。 结果 BP神经网络建立的截肢者健侧和假肢侧的运动学映射模型,综合关联度达到98.7%。相对于传统髋离断假肢,动力髋离断假肢髋关节的最大屈曲角度提升了105.5%,截肢者的步态对称性指标SⅠ和RⅡ分别提升了74.2%和72.2%。 结论 动力型髋离断假肢控制系统能提高假肢穿戴者的步态对称性。     

假肢接受腔界面应力的有限元分析

假肢是用来代偿正常人体截肢部位机能和外表形状的装置,安装假肢是截肢患者恢复活动能力和外观的主要康复手段。假肢接受腔作为人与机械系统之间生物力学的界面,是截肢患者肢体残端和假肢之间载荷传递的惟一通道,必须根据患者的具体情况因人而异,以满足功能性、舒适性的要求。一个完整的残肢接受腔有限元模型包括几何模型、材料特性、载荷状况和模型边界条件。下肢残肢-假肢接受腔界面应力的有限元理论仿真要求能够达到快速建立几何模型、准确模拟不同部位的材质特性、定义人机界面的接触特征、精确施加动态载荷。假肢接受腔以人工假肢个性化制造为研究对象,运用有限元法进行生物力学分析,并集成了生物医学、三维计算机辅助设计技术和快速成型技术。     

膝上截肢患者穿截假肢后的功能评定

２０例膝上不同水平截肢患者穿戴假肢后，利用步态分析、步行能力及假肢的悬吊能力三项指标进行功能评定。结果综合评定优秀率以膝离断假肢为最佳达８９％，依次为大腿中下１／３截肢、大腿中段截肢、大腿中上１／３截肢，髋离断假肢功能评定优秀率最低。提示骨科医题应重视截肢平面的选择。同时步态分析、步行能力及假肢悬吊能力三项评定指标为完善下肢假肢功能的评定提供了有益的参考指标。本组２０例膝上不同水平截肢患者的假肢代     

假肢发展对截肢观念的影响

随着科学技术的发展和对假肢研究的深入 ,现代技术条件已允许假肢达到很高的对症性 ,从而满足各种各样的残肢条件和对假肢不同的功能要求。从普及型下肢假肢到全电脑控制智能仿生腿 ,从普通的美容上肢假肢到带感应控制的肌电控制假手 ,假肢技术发展的同时又促进了截肢手术的发展 ,对原来的截肢观念产生了影响 ,从而最大限度地保留了残肢的功能 ,使截肢后的患者能更好地发挥假肢的代偿功能。1　现代假肢的发展现代假肢的发展主要集中在两个方面 ,一是假肢接受腔 ,二是假肢零部件 ,特别是功能性部件 ,如膝关节、假脚。接受腔作为患者和假肢之…     

膝上截肢患者穿戴假肢后的功能评定

20例膝上不同水平截肢患者穿戴假肢后,利用步态分析、步行能力及假肢的悬吊能力三项指标进行功能评定。结果综合评定优秀率以膝离断假肢为最佳达89％,依次为大腿中下1/3截肢、大腿中段截肢、大腿中上1/3截肢,髋离断假肢功能评定优秀率最低。提示骨科医师应重视截肢平面的选择。同时步态分析、步行能力及假肢悬吊能力三项评定指标为完善下肢假肢功能的评定提供了有益的参考指标。本组20例膝上不同水平截肢患者的假肢代偿功能总优良率达76.6％。     

假肢技术的研究热点及发展趋势

安装假肢是截肢者代偿缺失的运动功能，回归社会的有效手段。假肢使用的效果不仅与截肢部位和截肢手术有关，而且假肢接受腔、假肢部件及其控制方法的性能和质量也直接影响其使用性能。随着信息科学、传感技术、材料科学及其相关科学技术的发展．假肢的性能得到了很大提高，假肢技术的研究也取得了很大进展。目前假肢技术的研究热点主要集中在以下几个方面：     

下肢假肢装配合的综合康复治疗

近年来由于外伤、感染、肿瘤及周围血管病等因素造成截肢的患者越来越多,据1987年统计全国有肢体残疾者755万人,其中约有45万人需要安装假肢［’j。由此看来此类患者的康复训练显得越来越重要。我科1993年至今共收住院的下肢截肢患者188例,对其中160例装配假肢的患者进行康复训练,收到满意效果。王资料与方法1．l一般资料160例下肢截肢患者来源于西安医科大学第一附属医院假肢装配中心。①选择大腿截肢平面为坐骨结节距残端距离为15～25。m共6O例,男48例,女12例;平均年龄24．5士72岁;装配假肢时间平均3．9月。随机分为大腿康复组与…     

Stubby prostheses in the rehabilitation of infants and small children with bilateral lower limb deficiencies

Stubby prostheses have been used in the habilitation of very small children with bilateral lower limb deficiencies, particularly bilateral above knee limb deficiencies. While we reported on "The Use of Stubbies For the Child with Bilateral Lower Limb Deficiencies" in 1973, the literature has very little except in relation to the geriatric amputee. We have continued since 1973 to use stubbies in the bilateral above knee limb deficient child, as well as in the child with an above knee/below knee combination, with great success in establishing early balance, followed within several months by the application of articulated prostheses with equal success in establishing independent walking without the use of crutches or walkers.     

Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface

Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user’s nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head) and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius) of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step inter-subject variability of these profiles by calculating variance-to-signal ratios. We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee’s nervous system.     

Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface

ABSTRACT: BACKGROUND: Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user's nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. METHODS: We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head) and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius) of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step intersubject variability of these profiles by calculating variance-to-signal ratios. RESULTS: We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. CONCLUSION: Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee's nervous system.     

Evaluation of amputees]

INTRODUCTION: Review of the literature about evaluation of amputees. MATERIALS AND METHODS: A search of the Medline and Reedoc databases with the key words lower limb amputee, upper limb amputee, evaluation of lower limb amputee, evaluation of upper limb amputee, survey of lower limb amputee, survey of upper limb and the same words in French for reports on the evaluation of amputees. RESULTS: Evaluations of amputees differ according to the level of amputation (lower or upper limb) and age (adult or child). They concern standing balance, walking (lower limb) and the mono- or bimanual prehensile capacities with or without prostheses in daily living activities and leisure (upper limb) as well as quality of life, personal satisfaction, psychological impact and, in particular, coping strategies. DISCUSSION: For lower-limb amputees, tools to evaluate include scales of deambulation, of which few are valid in French, and global scales (on locomotor capacities, quality of life and satisfaction), which have been recently validated, but only one of them is valid in French. For upper-limb amputees, specific and valid tools are not available for adults; however, for children some functional capacity scales in daily activities have been validated and take into account psychomotor development. None of these tools are valid in French, and their use is scattered and limited to validation studies. CONCLUSION: Only a few tools to evaluate amputees are valid in French for adults, and they concern lower-limb amputees only. Validating some of these tools in French is necessary.     

The impact of lower-limb prosthetic limb use in international C4 track para-cycling

Abstract

An investigation was undertaken to ascertain any impact or significance of athletes within the C4 paracycling classification between those who use a lower-limb prostheses and those who do not. A statistical evaluation of event completion time was undertaken to assess C4 cyclists when competing at the World Championships and the Paralympic Games in the 1?km track time trial. The C4 athletes who utilize a prostheses consistently outperformed non-amputees in the C4 classification from 2011 to 2016 on a competition-to-competition basis. However, when the participations were grouped as a whole together and an identified outlier athlete was removed, it was then demonstrated that there was no statistical significance between those who required the use of a lower-limb prostheses to those that did not when either evaluated on a competition-by-competition or on an amputee and non-amputee group-by-group basis (p?≥?0.05). As a result, this study proposes that those requiring the use of lower-limb prostheses are neither advantaged nor disadvantaged in the C4 classification category when competing in the 1?km time trial at this time.

• Implications for Rehabilitation

• This analysis indicates that at this time, there is no evidence to suggest that use of such technology is advantageous in this category or should be seen as controversial.

• The design of lower-limb prosthetic limb technology in cycling should continue to be developed and optimized unabated.

• This study begins to address the cited lack of peer-reviewed information regarding paracycling with limb absence available to practitioners.

     

Investigations of roll-over shape: implications for design,alignment, and evaluation of ankle-foot prostheses and orthoses

Purpose.?The purpose of this article is to provide an overview of our previous work on roll-over shapes, which are the effective rocker shapes that the lower limb systems conform to during walking.

Method.?This article is a summary of several recently published articles from the Northwestern University Prosthetics Research Laboratory and Rehabilitation Engineering Research Program on the topic of roll-over shapes. The roll-over shape is a measurement of centre of pressure of the ground reaction force in body-based coordinates. This measurement is interpreted as the effective rocker shape created by lower limb systems during walking.

Results.?Our studies have shown that roll-over shapes in able-bodied subjects do not change appreciably for conditions of level ground walking, including walking at different speeds, while carrying different amounts of weight, while wearing shoes of different heel heights, or when wearing shoes with different rocker radii. In fact, results suggest that able-bodied humans will actively change their ankle movements to maintain the same roll-over shapes.

Conclusions.?The consistency of the roll-over shapes to level surface walking conditions has provided insight for design, alignment and evaluation of lower limb prostheses and orthoses. Changes to ankle-foot and knee-ankle-foot roll-over shapes for ramp walking conditions have suggested biomimetic (i.e. mimicking biology) strategies for adaptable ankle-foot prostheses and orthoses.     

Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration

PURPOSE: The purpose of this review is to summarize the literature related to the advances that have taken place in the management and rehabilitation care of limb amputation. RESULTS: Prostheses for the lower and upper limb amputee have changed greatly over the past several years, with advances in components, socket fabrication and fitting techniques, suspension systems and sources of power and electronic controls. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent life styles. This is of particular importance for the multi-limb amputee. The rehabilitation of more traditional lower limb levels of amputation have also greatly benefited from the technological advances including energy storing feet, electronic control hydraulic knees, ankle rotators and shock absorbers to mention a few. For the upper limb amputee, myoelectric and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation facilities. Experimental prosthetic fitting techniques and devices such as the use of osseo-implantation for suspension of the prosthesis, tension control hands or electromagnetic fluids for knee movement control will also be briefly discussed in this paper. CONCLUSION: It is possible to conclude from this review that many advances have occurred that have greatly impacted the functional outcomes of patients with limb amputation.     

Effects of prosthetic mass and mass distribution on kinematics and energetics of prosthetic gait: a systematic review

OBJECTIVE: To introduce the theoretical models used in literature that describe the relation between prosthetic inertial loading and amputee gait and to derive specific predictions from these models: to systematically review experimental studies on the relation between prosthetic inertial loading and energetics and kinematics of lower-limb prosthetic gait; and to compare the review outcomes with predictions derived from theoretical models. DATA SOURCES: Studies selected from Medline and from examining references in the selected Medline publications. STUDY SELECTION: Theoretical models were selected that are used in the present literature to predict the effects of prosthetic mass and mass distribution on kinematics and energetics of prosthetic gait. Experimental studies were selected that investigated the effects of prosthetic mass or center of mass location on the economy, self-selected walking speed, stride length, or stride frequency of lower limb amputee patients. DATA EXTRACTION: The design and methodologic quality was assessed using a checklist of nine criteria. Data on economy, self-selected walking speed, stride frequency, and stride length were extracted from the studies selected. DATA SYNTHESIS: The predictions of the theoretical models suggest that inertial loading of the present lightweight prostheses need not be decreased and sometimes may need to be increased to improve the gait of amputee patients. The methodologic quality of most of the experimental studies was limited. Review of the experimental studies suggests that the inertial loading of the present lightweight prostheses need not be further reduced. The discrepancy between theoretical models and experimental findings may be related to both the poor methodologic quality of the experiments as well as to the limited predictive value of the existing models.     

Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration

Purpose: The purpose of this review is to summarize the literature related to the advances that have taken place in the management and rehabilitation care of limb amputation.

Results: Prostheses for the lower and upper limb amputee have changed greatly over the past several years, with advances in components, socket fabrication and fitting techniques, suspension systems and sources of power and electronic controls. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent life styles. This is of particular importance for the multi-limb amputee. The rehabilitation of more traditional lower limb levels of amputation have also greatly benefited from the technological advances including energy storing feet, electronic control hydraulic knees, ankle rotators and shock absorbers to mention a few. For the upper limb amputee, myoelectric and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation facilities. Experimental prosthetic fitting techniques and devices such as the use of osseo-implantation for suspension of the prosthesis, tension control hands or electromagnetic fluids for knee movement control will also be briefly discussed in this paper.

Conclusion: It is possible to conclude from this review that many advances have occurred that have greatly impacted the functional outcomes of patients with limb amputation.