Crossover study of amputee stair ascent and descent biomechanics using Genium and C-Leg prostheses with comparison to non-amputee control.
Derek J Lura, Matthew W Wernke, Stephanie L Carey and 3 others
PMID 28763712WHAT IT FOUND
In stair ascent, 17 of 20 amputees could use step-over-step with Genium, compared with 4 with C-Leg. 7 preferred it, compared with 1.
Stair descent did not differ between knees.
Key findings
01For stair ascent, 17 participants could use a step-over-step pattern with the Genium and 7 preferred it, compared with 4 able and 1 preferring it with the C-Leg, a significant increase.
02For stair descent, all participants could use a step-over-step pattern with both knees, and 3 preferred step-to with the C-Leg and 1 with the Genium, but there was no significant difference in ability or preference.
03During step-over-step ascent, the Genium prosthetic knee had significantly greater maximum knee bend than the C-Leg prosthetic knee, but its swing time was significantly longer.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 20 transfemoral amputees and 5 controls were studied, so the results may not apply to all amputees. Group sizes were uneven because participants were not asked to use step-to if they preferred step-over-step, and not all could use step-over-step. The staircase had only three steps, so it is unclear whether the same patterns would hold for longer stair flights. Only the first two steps were instrumented, and step-over-step identification relied partly on visual assessment. For descent, too few participants preferred step-to to analyze that pattern statistically. Age and residual limb length effects were not planned analyses and involved small subgroups. Participants received study physical therapist training and a personal accommodation period, so the knee effect is tied to that training and fitting process.
The easy way to misread this
Do not conclude the Genium knee alone makes stair use better. 10 of 17 participants who could ascend step-over-step still preferred step-to, descent showed no difference between knees, and all amputee users received study physical therapist training and accommodation.