Medical Engineering & Physics
Volume 32, Issue 4 , Pages 312-323 , May 2010

Real-time subject-specific analyses of dynamic internal tissue loads in the residual limb of transtibial amputees

  • Sigal Portnoy

      Affiliations

    • Department of Biomedical Engineering, Tel Aviv University, Ramat Aviv, Israel
  • ,
  • Judith van Haare

      Affiliations

    • Department of Movement Sciences, Maastricht University, Maastricht, The Netherlands
  • ,
  • Richard P.J. Geers

      Affiliations

    • Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
  • ,
  • Anat Kristal

      Affiliations

    • Department of Orthopaedic Rehabilitation, Chaim Sheba Medical Center, Israel
  • ,
  • Itzhak Siev-Ner

      Affiliations

    • Department of Orthopaedic Rehabilitation, Chaim Sheba Medical Center, Israel
  • ,
  • Henk A.M. Seelen

      Affiliations

    • Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
    • Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
  • ,
  • Cees W.J. Oomens

      Affiliations

    • Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
  • ,
  • Amit Gefen

      Affiliations

    • Department of Biomedical Engineering, Tel Aviv University, Ramat Aviv, Israel
    • Corresponding Author InformationCorresponding author at: Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel. Tel.: +972 3 640 8093; fax: +972 3 640 5845.

Received 7 September 2009 ,Revised 20 December 2009 ,Accepted 23 December 2009.

References 

  1. Portnoy S, Yizhar Z, Shabshin N, Itzchak Y, Kristal A, Dotan-Marom Y, et al. Internal mechanical conditions in the soft tissues of a residual limb of a trans-tibial amputee. J Biomech. 2008;41:1897–1909
  2. Black J. Deep tissue injury: an evolving science. Ostomy Wound Manage. 2009;55:4
  3. Gefen A. Deep tissue injury from a bioengineering point of view. Ostomy Wound Manage. 2009;55:26–36
  4. Stekelenburg A, Gawlitta D, Bader DL, Oomens CW. Deep tissue injury: how deep is our understanding?. Arch Phys Med Rehabil. 2008;89:1410–1413
  5. Dudek NL, Marks MB, Marshall SC, Chardon JP. Dermatologic conditions associated with use of a lower-extremity prosthesis. Arch Phys Med Rehabil. 2005;86:659–663
  6. Meulenbelt HE, Geertzen JH, Jonkman MF, Dijkstra PU. Determinants of skin problems of the stump in lower-limb amputees. Arch Phys Med Rehabil. 2009;90:74–81
  7. Kulkarni J, Pande S, Morris J. Survival rates in dysvascular lower limb amputees. Int J Surg. 2006;4:217–221
  8. Paysant J, Beyaert C, Datie AM, Martinet N, Andre JM. Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees. J Rehabil Res Dev. 2006;43:153–160
  9. Schmalz T, Blumentritt S, Marx B. Biomechanical analysis of stair ambulation in lower limb amputees. Gait Posture. 2007;25:267–278
  10. Dou P, Jia X, Suo S, Wang R, Zhang M. Pressure distribution at the stump/socket interface in transtibial amputees during walking on stairs, slope and non-flat road. Clin Biomech. 2006;21:1067–1073
  11. Salawu A, Middleton C, Gilbertson A, Kodavali K, Neumann V. Stump ulcers and continued prosthetic limb use. Prosthet Orthot Int. 2006;30:279–285
  12. Portnoy S, Yarnitzky G, Yizhar Z, Kristal A, Oppenheim U, Siev-Ner I, et al. Real-time patient-specific finite element analysis of internal stresses in the soft tissues of a residual limb: a new tool for prosthetic fitting. Ann Biomed Eng. 2007;35:120–135
  13. Yang F. Asymptotic solution to axisymmetric indentation of a compressible elastic thin film. Thin Solid Films. 2006;515:2274–2283
  14. Mak AF, Liu GH, Lee SY. Biomechanical assessment of below-knee residual limb tissue. J Rehabil Res Dev. 1994;31:188–198
  15. Sanders JE, Greve JM, Mitchell SB, Zachariah SG. Material properties of commonly-used interface materials and their static coefficients of friction with skin and socks. J Rehabil Res Dev. 1998;35:161–176
  16. Zhang M, Turner-Smith AR, Roberts VC, Tanner A. Frictional action at lower limb/prosthetic socket interface. Med Eng Phys. 1996;18:207–214
  17. Portnoy S, Siev-Ner I, Shabshin N, Kristal A, Yizhar Z, Gefen A. Patient-specific analyses of deep tissue loads post transtibial amputation in residual limbs of multiple prosthetic users. J Biomech. 2009;42:2686–2693
  18. Jia X, Zhang M, Lee WC. Load transfer mechanics between trans-tibial prosthetic socket and residual limb – dynamic effects. J Biomech. 2004;37:1371–1377
  19. Su PF, Gard SA, Lipschutz RD, Kuiken TA. Gait characteristics of persons with bilateral transtibial amputations. J Rehabil Res Dev. 2007;44:491–501
  20. Vickers DR, Palk C, McIntosh AS, Beatty KT. Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis. Gait Posture. 2008;27:518–529
  21. Linder-Ganz E, Engelberg S, Scheinowitz M, Gefen A. Pressure–time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics. J Biomech. 2006;39:2725–2732
  22. Sanders JE, Bell DM, Okumura RM, Dralle AJ. Effects of alignment changes on stance phase pressures and shear stresses on transtibial amputees: measurements from 13 transducer sites. IEEE Trans Rehabil Eng. 1998;6:21–31
  23. Hafner BJ, Sanders JE, Czerniecki J, Fergason J. Energy storage and return prostheses: does patient perception correlate with biomechanical analysis?. Clin Biomech (Bristol, Avon). 2002;17:325–344
  24. Hafner BJ. Clinical prescription and use of prosthetic foot and ankle mechanisms: a review of the literature. J Prosthet Orthot. 2005;17:5–11
  25. Rao SS, Boyd LA, Mulroy SJ, Bontrager EL, Gronley JK, Perry J. Segment velocities in normal and transtibial amputees: prosthetic design implications. IEEE Trans Rehabil Eng. 1998;6:219–226
  26. Portnoy S, Siev-Ner I, Yizhar Z, Kristal A, Shabshin N, Gefen A. Surgical and morphological factors that affect internal mechanical loads in soft tissues of the transtibial residuum. Ann Biomed Eng. 2009;37:2583–2605
  27. Picinbono G, Delingette H, Ayache N. Non-linear anisotropic elasticity for real-time surgery simulation. Graphical Models. 2003;65:305–321
  28. Cotin S, Delingette H, Ayache N. Real-time elastic deformations of soft tissues for surgery simulation. IEEE Trans Vis Comput Graph. 2009;5:62–73
  29. Linder-Ganz E, Yarnitzky G, Yizhar Z, Siev-Ner I, Gefen A. Real-time finite element monitoring of sub-dermal tissue stresses in individuals with spinal cord injury: towards prevention of pressure ulcers. Ann Biomed Eng. 2009;37:387–400
  30. Yarnitzky G, Yizhar Z, Gefen A. Real-time subject-specific monitoring of internal deformations and stresses in the soft tissues of the foot: a new approach in gait analysis. J Biomech. 2006;39:2673–2689
  31. Sanders JE, Zachariah SG, Jacobsen AK, Fergason JR. Changes in interface pressures and shear stresses over time on trans-tibial amputee subjects ambulating with prosthetic limbs: comparison of diurnal and six-month differences. J Biomech. 2005;38:1566–1573

PII: S1350-4533(09)00267-7

doi: 10.1016/j.medengphy.2009.12.006

Medical Engineering & Physics
Volume 32, Issue 4 , Pages 312-323 , May 2010