TY - JOUR
T1 - Functional Performance Outcomes of a Powered Knee–Ankle Prosthesis in Service Members With Unilateral Transfemoral Limb Loss
AU - Knight, Ashley D.
AU - Jayaraman, Chandrasekaran
AU - Elrod, Jonathan M.
AU - Schnall, Barri L.
AU - McGuire, Matt S.
AU - Sleeman, Todd J.
AU - Hoppe-Ludwig, Shenan
AU - Dearth, Christopher L.
AU - Hendershot, Brad D.
AU - Jayaraman, Arun
N1 - Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Introduction: Clinical knowledge surrounding functional outcomes of a powered knee–ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training. Materials and Methods: Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment. Results: All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis. Conclusions: Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.
AB - Introduction: Clinical knowledge surrounding functional outcomes of a powered knee–ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training. Materials and Methods: Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment. Results: All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis. Conclusions: Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.
UR - http://www.scopus.com/inward/record.url?scp=85147747721&partnerID=8YFLogxK
U2 - 10.1093/milmed/usac231
DO - 10.1093/milmed/usac231
M3 - Article
C2 - 35895305
AN - SCOPUS:85147747721
SN - 0026-4075
VL - 188
SP - 3432
EP - 3438
JO - Military Medicine
JF - Military Medicine
IS - 11-12
ER -