The development of a new stance controlled orthotic knee joint
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Development and Evaluation of a Mechanical Stance-Controlled Orthotic Knee Joint With Stance Flexion
Stance-control orthotic knee joints stabilize the knee joint during the weight-bearing portion of gait without restricting swing-phase flexion, thus achieving a more normal gait for individuals with quadriceps muscle weakness. These devices must be designed around well-defined stance-control strategies that enable or hinder joint motion at specific events during the gait cycle. This paper presents a new type of stance-control strategy and a novel stance-controller design. Pilot clinical testing was performed on a prototype, demonstrating feasibility of this approach for providing reliable knee stability while facilitating swing-phase flexion. In particular, 44 deg of swing-phase flexion and 15 deg of stance-phase flexion were achieved during level walking. Further testing is needed in situ to provide additional validation and assess other mobility conditions.
Knee flexion
Gait cycle
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Knee flexion
Biomechanics
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Persons with quadriceps muscle weakness are often prescribed a knee-ankle-foot orthosis that locks the knee in full extension during both stance and swing phases of gait. Locking the knee results in abnormal gait patterns characterized by hip hiking and leg circumduction during swing. The stance-control knee-ankle-foot orthosis (SCKAFO), a new type of orthosis, has emerged that permits free knee motion during swing while resisting knee flexion during stance, thereby supporting the limb during weight-bearing. This article examines various SCKAFO designs, discuss the existing design limitations, and identify remaining design challenges. Several commercial SCKAFOs have been released that incorporate different locking mechanisms. Preliminary gait studies have shown some devices to be promising; however, an important functional limitation in some SCKAFOs is dependence on specific joint angles to switch between stance and swing modes. Important design factors such as size, weight, and noise must be considered in new orthosis designs to ensure wide consumer acceptance.
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ABSTRACT Background The aim of this study was to develop a new stance control knee-ankle-foot orthosis (SCKAFO) and determine its efficacy on specific spatiotemporal and kinematic parameters. Method Seven healthy volunteer subjects participated in this study. After orthotic gait training, subjects participated in a four-part data collection session that consisted of gait evaluation with normal walking, SCKAFO with locked knee joint, SCKAFO without initial flexion (IF) mode, and SCKAFO with IF mode. Results Walking with any of the control knee-ankle-foot orthoses (KAFOs) produced a significant reduction in walking speed compared with normal walking. There was no significant difference in walking speed between the SCKAFO with and without IF. There was significantly higher knee flexion in stance phase when walking with the SCKAFO with IF compared with the other types of KAFO, but there was no significant difference between normal walking and SCKAFO with IF. In wearing SCKAFO with IF, the mean of the hip flexion was not significantly altered compared with normal walking. Hip abduction was also significantly reduced during walking with stance control (SC) mode compared to KAFO with locked knee joint. Conclusion Knee-ankle-foot orthosis with new powered knee joint has benefits over existing assistive KAFOs with locked and SC knee joints.
Knee flexion
Foot (prosody)
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Background and aim: Most currently-available stance control knee ankle foot orthoses (SCKAFOs) still need full knee extension to lock the knee joint, and they are still noisy, bulky, and heavy. Therefore, the aim of this study was to design, construct, and evaluate an original electromechanical SCKAFO knee joint that could feasibly solve these problems, and thus address the problems of current stance control knee joints with regards to their structure, function, cosmesis, and cost.Method: Ten able-bodied (AB) participants and two (knee ankle foot orthosis) KAFO users were recruited to participate in the study. A custom SCKAFO with the same set of components was constructed for each participant. Lower limb kinematics were captured using a 6-camera, video-based motion analysis system.Results: For AB participants, significant differences were found between normal walking and walking with the SCKAFO for temporal-spatial parameters and between orthoses with two modes of knee joints in the healthy subjects. Walking with stance control mode produced greater walking speed and step length, greater knee flexion during swing, and less pelvic obliquity than walking with a locked knee, for both AB and KAFO users.Conclusions: The feasibility of this new knee joint with AB people was demonstrated.Implications for rehabilitationStance control knee ankle foot orthoses (SCKAFOs) are designed to stop knee flexion in stance phase and provide free knee movement during swing phase of walking.Due to their high cost, size, excessive weight, and poor performance, few SCKAFO were optimal clinically and commercially.The feasibility of the new knee joint with able-bodied people and poliomyelitis subjects was demonstrated.
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본 연구의 목적은 소아마비, 하지 근력약화 등의 장애인이 사용하는 잠금형 보조기무릎관절을 대체하기 위하여, 4절 연쇄 방식의 입각기조절형 보조기무릎관절을 개발하는 것이다. 본 연구에서 개발한 4절 연쇄 보조기무릎관절은 기존의 입각기조절형 보조기무릎관절과 달리, 기하학적으로 잠금상태가 제어되어 전기제어 부품 등이 필요하지 않으며 부피를 최소화하였다. 평가를 위하여, 소아마비로 진단받고 잠금형 보조기무릎관절을 사용해온 소아마비자가 대상자로 참여하였다. 대상자의 걸음걸이를 3차원으로 분석한 결과, 4절 연쇄 보조기무릎관절을 착용했을 때 입각기 동안 무릎관절의 신전이 유지되고 유각기 동안 무릎관절이 굴곡되며 자연스러운 걸음걸이를 보여주었다. This study aims to develop the stance-control typed 4-bar linkage orthotic knee joint that replace the locked orthotic knee joint for the disabled with poliomyelitis and muscle weakness of lower limb. Unlike the existing stance-control orthotic knee joint, there are no needs of electric power, connecting circuit, bulky compomnets, etc, because this 4-bar linkage orthotic knee joint is controled by geometric locking. To evaluate the 4-bar linkage orthotic knee joint, a subject participated in this study who has been diagnosed with lower limb poliomyelitis and have used locked type orthotic knee joint. In the results of analysis of subject's gait using 3-dimentional motion analysis system, this 4-bar linkage orthotic knee joint provide the stability during stance phase and knee flexion during swing phase.
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Users of traditional knee-ankle-foot orthoses (KAFOs) walk with either locked or unlocked knee joints depending on the level of stability required. Some users may benefit from new stance-control KAFOs that prevent stance-phase knee flexion but allow swing-phase flexion. We collected data from nine nondisabled adults who walked with KAFOs that incorporated the Horton Stance-Control Orthotic Knee Joint (SCOKJ) in the locked, unlocked, and auto (which provides knee stability during stance phase and knee flexion during swing phase) modes to investigate the biomechanical and energetic effects of stance-control orthoses. Studying nondisabled subjects allowed us to analyze the effects of stance-control orthoses in a homogenous population. In general, gait kinematics for the auto and unlocked modes were more similar than for the auto and locked modes. Despite the elimination of hip hiking in the auto mode, oxygen cost was not different between the auto and locked modes (p > 0.99). The SCOKJ allowed our nondisabled subjects to walk with a more normal gait pattern; however, future research should explore the effect of stance-control orthoses on persons with gait pathology.
Knee flexion
Biomechanics
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