The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Laurent Frossard - One of the best experts on this subject based on the ideXlab platform.
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loading effect of prosthetic feet s anthropomorphicity on transtibial Osseointegrated Implant
Military Medicine, 2021Co-Authors: Mark Pitkin, Laurent FrossardAbstract:INTRODUCTION: Osseointegrated Implants for direct skeletal attachment of transtibial prosthesis carry risks that are yet to be fully resolved, such as early loosening, mechanical failure of percutaneous and medullar parts of Implant, periprosthetic issues, and infections. Underloading could lead to early loosening and infection. Overloading might compromise the bone-Implant interface. Therefore, Goldilocks loading regimen applied by transtibial bone-anchored prostheses is critical for safe and efficient development of osseointegration around the Implant during rehabilitation and beyond. We hypothesized that Goldilocks loading could be achieved when ambulating with a so-called anthropomorphic prosthetic ankle showing moment-angle relationship similar to a sound ankle. MATERIALS AND METHODS: Quantitative characteristics of the moment-angle curve of the sound ankle during dorsiflexion phase of a free-pace walking were extracted for 4 able-bodied participants (experiment 1). A slope of the moment-angle curve (stiffness) was calculated twice: for the first half and for the second half of the moment-angle curve. The difference of stiffnesses (those at the second half minus at the first half) was called the index of anthropomorphicity (IA). By definition, positive IA is associated with concave shape of the moment-angle curve, and the negative IA is associated with convex shape. In experiment 2, the same recordings and calculations were performed for 3 participants fitted with transtibial Osseointegrated fixation during walking with their usual feet and the Free-Flow Foot (Ohio Willow Wood). The Free-Flow Foot was selected for its anthropomorphicity demonstrated in the previous studies with amputees using traditional socket attachment. RESULTS: The IA was 5.88 ± 0.93 for the able-bodied participants, indicating that the stiffness during the first part of the dorsiflexion phase was substantially fewer than during the second parts, as the calf muscles resisted to angulation in ankle substantially less than during the second part of dorsiflexion phase. For amputees fitted with Free-Flow Foot, IA was 2.68 ± 1.09 and -2.97 ± 2.37 for the same amputees fitted with their usual feet. CONCLUSIONS: Indexes of anthropomorphicity, while of different magnitude, were positive in control able-bodied group and in the amputee group wearing Free-Flow Foot, which was qualitatively associated with concave shape of their moment-angle curves. The 3 usual feet worn by the participants were classified as nonanthropomorphic as their individual moment-angle curves were convex and the corresponding IAs were negative. Furthermore, this study showed that a foot with anthropomorphic characteristics tends to decrease maximal loads at the bone-Implant interface as compared to the nonanthropomorphic feet and possibly may minimize the risks to compromise the integrity of this interface.
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inter participant variability data in loading applied on Osseointegrated Implant by transtibial bone anchored prostheses during daily activities
Data in Brief, 2019Co-Authors: Laurent Frossard, Barry Leech, Mark PitkinAbstract:The data in this paper are related to the research article entitled “Loading applied on Osseointegrated Implant by transtibial bone-anchored prostheses during daily activities: Preliminary characterization of prosthetic feet” (Frossard et al., 2019: Accepted). This article contains the individual and grouped loading characteristics applied on transtibial Osseointegrated Implant generated while walking with bone-anchored prostheses including prosthetic feet with different index of anthropomorphicity. Inter-participant variability was presented for (A) the spatio-temporal characteristics, (B) the loading boundaries and (C) the loading local extremum during walking, ascending and descending ramp and stairs. These initial inter-participant variability benchmark datasets are critical to improve the efficacy and safety of prosthetic components for transtibial prostheses as well as the design of future automated algorithms and clinical trials. Online repository contains the files: https://doi.org/10.17632/vhc6sf7ngy.1.
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loading characteristics data applied on Osseointegrated Implant by transfemoral bone anchored prostheses fitted with basic components during daily activities
Data in Brief, 2019Co-Authors: Laurent FrossardAbstract:Abstract The data in this paper are related to the research articles entitled “Kinetics of transfemoral amputees with Osseointegrated fixation performing common activities of daily living” (Lee et al., Clinical Biomechanics, 2007.22(6). p. 665–673) and “Magnitude and variability of loading on the Osseointegrated Implant of transfemoral amputees during walking” (Lee et al., Med Eng Phys, 2008.30(7). p. 825–833). This article contains the overall and individual loading characteristics applied on screw-type Osseointegrated Implant generated by transfemoral bone-anchored prostheses fitted with basic components during daily activities at self-selected comfortable pace. Overall and individual data was presented for the (A) spatio-temporal characteristics, (B) loading patterns, (C) loading boundaries and (D) the loading local extremum during level walking, ascending and descending ramp and stairs. Inter-participant variability of these new datasets with basic components is critical to improve the efficacy and safety of prosthetic components as well as the design of future automated algorithms and clinical trials. Online repository contains the files: https://data.mendeley.com/datasets/hh8rjjh73w/1.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant loading compliance
Prosthetics and Orthotics International, 2017Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background Load bearing exercises (LBEs) are performed by transfemoral amputees (TFA) fitted with an Osseointegrated Implant to facilitate bone remodelling. Objective This study presents the loading compliance comparing loads prescribed and applied on the three axes of the Implant during static LBEs with a specific emphasis on axial and vectorial comparisons. Methods Eleven fully rehabilitated unilateral TFAs fitted with an Osseointegrated Implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the Implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the Implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. Results The results demonstrated that axial and vectorial differences were significant in all conditions (p<0.05), except for the vectorial difference for the 40 kg condition (p=0.182). Conclusions The significant lack of axial compliance led to systematic underloading of the long axis of the Implant.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant reliability of kinetic data
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an Osseointegrated Implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( $\%{\hbox{SEMs}}$ ). The ICCs of all variables were above 0.9 and the $\%{\hbox{SEM}}$ values ranged between 0 and ${\hbox{87}}\%$ . This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
Rickard Branemark - One of the best experts on this subject based on the ideXlab platform.
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myoelectric signals and pattern recognition from Implanted electrodes in two tmr subjects with an Osseointegrated communication interface
International Conference of the IEEE Engineering in Medicine and Biology Society, 2018Co-Authors: Rickard Branemark, Oskar C. AszmannAbstract:Permanent Implantation of electrodes for prosthetic control is now possible using an Osseointegrated Implant as a long-term stable communication interface (e-OPRA). The number of myoelectric sites to host such electrodes can be increased by Targeted Muscle Reinnervation (TMR). Traditionally, patients need to wait several months before the TMR signals are strong enough to be recorded by electrodes placed over the skin. In this study, we report the evolution of the TMR myoelectric signals recorded from two subjects via Implanted electrodes using e-OPRA, and monitored for up to 48 weeks after surgery. The signals were analyzed with regard to amplitude (signal-to-noise ratio), independence (cross-correlation) and myoelectric pattern recognition (classification accuracy). TMR signals appeared at the first follow-up, one month post-surgery, and developed around 20 dB by the last. Cross-correlation between signals decreased over time and converged to a few percentage points. Classification accuracies were over 97% by the last follow up. These preliminary results suggest that Implanted electrodes via the e-OPRA interface allow for an earlier and more effective use of motor signals from TMR sites compared to conventional skin surface electrodes.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant loading compliance
Prosthetics and Orthotics International, 2017Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background Load bearing exercises (LBEs) are performed by transfemoral amputees (TFA) fitted with an Osseointegrated Implant to facilitate bone remodelling. Objective This study presents the loading compliance comparing loads prescribed and applied on the three axes of the Implant during static LBEs with a specific emphasis on axial and vectorial comparisons. Methods Eleven fully rehabilitated unilateral TFAs fitted with an Osseointegrated Implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the Implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the Implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. Results The results demonstrated that axial and vectorial differences were significant in all conditions (p<0.05), except for the vectorial difference for the 40 kg condition (p=0.182). Conclusions The significant lack of axial compliance led to systematic underloading of the long axis of the Implant.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant reliability of kinetic data
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an Osseointegrated Implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( $\%{\hbox{SEMs}}$ ). The ICCs of all variables were above 0.9 and the $\%{\hbox{SEM}}$ values ranged between 0 and ${\hbox{87}}\%$ . This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant
Faculty of Health; Institute of Health and Biomedical Innovation, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant conference abstract
Prosthetics and Orthotics International, 2015Co-Authors: Pascal Coorevits, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
Sofie Vertriest - One of the best experts on this subject based on the ideXlab platform.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant loading compliance
Prosthetics and Orthotics International, 2017Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background Load bearing exercises (LBEs) are performed by transfemoral amputees (TFA) fitted with an Osseointegrated Implant to facilitate bone remodelling. Objective This study presents the loading compliance comparing loads prescribed and applied on the three axes of the Implant during static LBEs with a specific emphasis on axial and vectorial comparisons. Methods Eleven fully rehabilitated unilateral TFAs fitted with an Osseointegrated Implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the Implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the Implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. Results The results demonstrated that axial and vectorial differences were significant in all conditions (p<0.05), except for the vectorial difference for the 40 kg condition (p=0.182). Conclusions The significant lack of axial compliance led to systematic underloading of the long axis of the Implant.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant reliability of kinetic data
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an Osseointegrated Implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( $\%{\hbox{SEMs}}$ ). The ICCs of all variables were above 0.9 and the $\%{\hbox{SEM}}$ values ranged between 0 and ${\hbox{87}}\%$ . This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant
Faculty of Health; Institute of Health and Biomedical Innovation, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
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static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with Osseointegrated Implant load compliance
American Orthotic And Prosthetic Association (AOPA) World Congress, 2013Co-Authors: Sofie Vertriest, Pascal Coorevits, Laurent FrossardAbstract:Osseointegration has been introduced in the orthopaedic surgery in the 1990’s in Gothenburg (Sweden). To date, there are two frequently used commercially available human Implants: the OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany) systems. The rehabilitation program with both systems include some form of static load bearing exercises. These latter involved following a load progression that is monitored by the bathroom scale, providing only the load applied on the vertical axis. The loading data could be analysed through different biomechanical variables. For instance, the load compliance, corresponding to the difference between the load recommended (LR) and the load actually applied on the Implant, will be presented here.
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static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with Osseointegrated Implant kinetic analysis
World Congress of the International Society for Prosthetics and Orthotics (ISPO), 2013Co-Authors: Sofie Vertriest, Pascal Coorevits, Laurent FrossardAbstract:The desire to solve problems caused by socket prostheses in transfemoral amputees and the acquired success of osseointegration in the dental application has led to the introduction of osseointegration in the orthopedic surgery. Since its first introduction in 1990 in Gothenburg Sweden the Osseointegrated (OI) orthopedic fixation has proven several benefits[1]. The surgery consists of two surgical procedures followed by a lengthy rehabilitation program. The rehabilitation program after an OI Implant includes a specific training period with a short training prosthesis. Since mechanical loading is considered to be one of the key factors that influence bone mass and the osseointegration of bone-anchored Implants, the rehabilitation program will also need to include some form of load bearing exercises (LBE). To date there are two frequently used commercially available human Implants. We can find proof in the literature that load bearing exercises are performed by patients with both types of OI Implants. We refer to two articles, a first one written by Dr. Aschoff and all and published in 2010 in the Journal of Bone and Joint Surgery.[2] The second one presented by Hagberg et al in 2009 gives a very thorough description of the rehabilitation program of TFA fitted with an OPRA Implant. The progression of the load however is determined individually according to the residual skeleton’s quality, pain level and body weight of the participant.[1] Patients are using a classical bathroom weighing scale to control the load on the Implant during the course of their rehabilitation. The bathroom scale is an affordable and easy-to-use device but it has some important shortcomings. The scale provides instantaneous feedback to the patient only on the magnitude of the vertical component of the applied force. The forces and moments applied along and around the three axes of the Implant are unknown. Although there are different ways to assess the load on the Implant for instance through inverse dynamics in a motion analysis laboratory [3-6] this assessment is challenging. A recent proof- of-concept study by Frossard et al (2009) showed that the shortcomings of the weighing scale can be overcome by a portable kinetic system based on a commercial transducer[7].
Pascal Coorevits - One of the best experts on this subject based on the ideXlab platform.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant loading compliance
Prosthetics and Orthotics International, 2017Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background Load bearing exercises (LBEs) are performed by transfemoral amputees (TFA) fitted with an Osseointegrated Implant to facilitate bone remodelling. Objective This study presents the loading compliance comparing loads prescribed and applied on the three axes of the Implant during static LBEs with a specific emphasis on axial and vectorial comparisons. Methods Eleven fully rehabilitated unilateral TFAs fitted with an Osseointegrated Implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the Implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the Implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. Results The results demonstrated that axial and vectorial differences were significant in all conditions (p<0.05), except for the vectorial difference for the 40 kg condition (p=0.182). Conclusions The significant lack of axial compliance led to systematic underloading of the long axis of the Implant.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant reliability of kinetic data
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an Osseointegrated Implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( $\%{\hbox{SEMs}}$ ). The ICCs of all variables were above 0.9 and the $\%{\hbox{SEM}}$ values ranged between 0 and ${\hbox{87}}\%$ . This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant
Faculty of Health; Institute of Health and Biomedical Innovation, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant conference abstract
Prosthetics and Orthotics International, 2015Co-Authors: Pascal Coorevits, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
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static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with Osseointegrated Implant load compliance
American Orthotic And Prosthetic Association (AOPA) World Congress, 2013Co-Authors: Sofie Vertriest, Pascal Coorevits, Laurent FrossardAbstract:Osseointegration has been introduced in the orthopaedic surgery in the 1990’s in Gothenburg (Sweden). To date, there are two frequently used commercially available human Implants: the OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany) systems. The rehabilitation program with both systems include some form of static load bearing exercises. These latter involved following a load progression that is monitored by the bathroom scale, providing only the load applied on the vertical axis. The loading data could be analysed through different biomechanical variables. For instance, the load compliance, corresponding to the difference between the load recommended (LR) and the load actually applied on the Implant, will be presented here.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant loading compliance
Prosthetics and Orthotics International, 2017Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background Load bearing exercises (LBEs) are performed by transfemoral amputees (TFA) fitted with an Osseointegrated Implant to facilitate bone remodelling. Objective This study presents the loading compliance comparing loads prescribed and applied on the three axes of the Implant during static LBEs with a specific emphasis on axial and vectorial comparisons. Methods Eleven fully rehabilitated unilateral TFAs fitted with an Osseointegrated Implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the Implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the Implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively. Results The results demonstrated that axial and vectorial differences were significant in all conditions (p<0.05), except for the vectorial difference for the 40 kg condition (p=0.182). Conclusions The significant lack of axial compliance led to systematic underloading of the long axis of the Implant.
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static load bearing exercises of individuals with transfemoral amputation fitted with an Osseointegrated Implant reliability of kinetic data
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an Osseointegrated Implant to stimulate the bone remodeling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalization. Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values ( $\%{\hbox{SEMs}}$ ). The ICCs of all variables were above 0.9 and the $\%{\hbox{SEM}}$ values ranged between 0 and ${\hbox{87}}\%$ . This study showed a high between-participants' variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant
Faculty of Health; Institute of Health and Biomedical Innovation, 2015Co-Authors: Sofie Vertriest, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Pascal Coorevits, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
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loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an Osseointegrated Implant conference abstract
Prosthetics and Orthotics International, 2015Co-Authors: Pascal Coorevits, Kerstin Hagberg, Eva Haggstrom, Rickard Branemark, Guy Vanderstraeten, Laurent FrossardAbstract:Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two Implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an Osseointegrated Implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the Implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA Implant performed five trials in four loading conditions. The forces and moments on the three axes of the Implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the Implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the Implant.
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magnitude and variability of loading on the Osseointegrated Implant of transfemoral amputees during walking
Medical Engineering & Physics, 2008Co-Authors: Winson C C Lee, Laurent Frossard, Kerstin Hagberg, Eva Haggstrom, David Lee Gow, Steven Gray, Rickard BranemarkAbstract:This study directly measured the load acting on the abutment of the Osseointegrated Implant system of transfemoral amputees during level walking, and studied the variability of the load within and among amputees. Twelve active transfemoral amputees (age: 54±12 years, mass:84.3±16.3 kg, height: 17.8±0.10 m) fitted with an Osseointegrated Implant for over 1 year participated in the study. The load applied on the abutment was measured during unimpeded, level walking in a straight line using a commercial six-channel transducer mounted between the abutment and the prosthetic knee. The pattern and the magnitude of the three-dimensional forces and moments were revealed. Results showed a low step-to-step variability of each subject, but a high subject-to-subject variability in local extrema of body-weight normalized forces and moments and impulse data. The high subject-to-subject variability suggests that the mechanical design of the Implant system should be customized for each individual, or that a fit-all design should take into consideration the highest values of load within a broad range of amputees. It also suggests specific loading regime in rehabilitation training are necessary for a given subject. Thus the loading magnitude and variability demonstrated should be useful in designing an Osseointegrated Implant system better able to resist mechanical failure and in refining the rehabilitation protocol.
