Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis

Eva Pröbsting, Andreas Kannenberg, Britta Zacharias, Eva Pröbsting, Andreas Kannenberg, Britta Zacharias

Abstract

Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg.

Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living.

Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis.

Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire.

Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation ( p = .001), paretic limb health ( p = .04), sounds ( p = .02), and well-being ( p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living.

Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.

Keywords: Lower limb orthotics; rehabilitation of orthoses users.

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors are employees of Otto Bock HealthCare, the manufacturer of the C-Brace.

Figures

Figure 1.
Figure 1.
C-Brace with its components.
Figure 2.
Figure 2.
Mean visual analogue scale (VAS) ratings and standard deviations of the nine subscales of (a) the Orthosis Evaluation Questionnaire (OEQ) for all patients, (b) SCO as previous orthosis, and (c) LKAFO as previous orthosis. The p value is given for all significant (p < .05) differences.
Figure 3.
Figure 3.
Mean ratings of difficulty of the five subscales of (a) the Orthotic ADLs Questionnaire (ADL-Q) for all patients, (b) SCO as previous orthosis, and (c) LKAFO as previous orthosis. The p value is given for all significant (p < .05) differences.
Figure 4.
Figure 4.
Distribution of the answers for the comparison of perceived (a) difficulty and (b) safety of the 45 activities of the Orthotic ADLs Questionnaire (ADL-Q) between the C-Brace and the previous orthoses.

References

    1. Irby SE, Bernhardt KA, Kaufman KR. Gait changes over time in stance control orthosis users. Prosthet Orthot Int 2007; 31(4): 353–361.
    1. Bernhardt KA, Irby SE, Kaufman KR. Consumer opinions of a stance control knee orthosis. Prosthet Orthot Int 2006; 30(3): 246–256.
    1. Yakimovich T, Lemaire ED, Kofman J. Engineering design review of stance-control knee-ankle-foot orthoses. J Rehabil Res Dev 2009; 46(2): 257–268.
    1. Davis PC, Bach TM, Pereira DM. The effect of stance control orthoses on gait characteristics and energy expenditure in knee-ankle-foot orthosis users. Prosthet Orthot Int 2010; 34(2): 206–215.
    1. Zissimopoulos A, Fatone S, Gard SA. Biomechanical and energetic effects of a stance-control orthotic knee joint. J Rehabil Res Dev 2007; 44(4): 503–514.
    1. Moreno JC, Brunetti F, Rocon E, et al. Immediate effects of a controllable knee ankle foot orthosis for functional compensation of gait in patients with proximal leg weakness. Med Biol Eng Comput 2008; 46(1): 43–53.
    1. Yakimovich T, Lemaire ED, Kofman J. Preliminary kinematic evaluation of a new stance-control knee-ankle-foot orthosis. Clin Biomech 2006; 21(10): 1081–1089.
    1. Hebert JS, Liggins AB. Gait evaluation of an automatic stance-control knee orthosis in a patient with postpoliomyelitis. Arch Phys Med Rehabil 2005; 86(8): 1676–1680.
    1. Hwang S, Kang S, Cho K, et al. Biomechanical effect of electromechanical knee-ankle-foot-orthosis on knee joint control in patients with poliomyelitis. Med Biol Eng Comput 2008; 46(6): 541–549.
    1. Schmalz T, Blumentritt S, Drewitz H. Gangphasenabhängig entriegelnde versus gesperrte Beinorthesen—biomechanische und metabolische Untersuchungen. Med Orthop Tech 2005; 125(3): 67–74.
    1. Zacharias B, Kannenberg A. Clinical benefits of stance control orthosis systems: an analysis of the scientific literature. J Prosthet Orthot 2012; 24(1): 2–8.
    1. Highsmith MJ, Kahle JT, Bongiorni DR, et al. Safety, energy efficiency, and cost-effectiveness of the C-leg for transfemoral amputees. Prosth Orthot Int 2010; 34(4): 362–377.
    1. Bellmann M, Schmalz T, Blumentritt S. Comparative biomechanical analysis of current microprocessor-controlled prosthetic knee joints. Arch Phys Med Rehabil 2010; 91(4): 644–652.
    1. Blumentritt S, Schmalz T, Jarasch R. The safety of C-leg: biomechanical tests. J Prosthet Orthot 2009; 21(1): 2–17.
    1. Wetz HH, Hafkemeyer U, Drerup B. Einfluss des C-Leg-Kniegelenk-Passteiles der Fa. Otto Bock auf die Versorgungsqualität Oberschenkelamputierter. Orthopäde 2005; 34(4): 298–319.
    1. Drerup B, Wetz HH, Tiemeyer K, et al. Langzeitergebnisse mit dem C-Leg Kniegelenksystem: qualitätskontrolle der Indikationsstellung der Klinischen Prüfstellen. Med Orth Tech 2010; 130(2): 7–16.
    1. Hafner BJ, Willingham LL, Buell NC, et al. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch Phys Med Rehabil 2007; 88(2): 207–217.
    1. Schmalz T, Proebsting E, Auberger R, et al. A functional comparison of conventional knee-ankle-foot orthoses and a microprocessor-controlled leg orthosis system based on biomechanical parameters. Prosthet Orthot Int 2016; 40(2): 277–286.
    1. Pahl E, Auberger R. Ganzbeinorthese mit kontrollierter Schwung- und Standphase. Orth Tech 2013; 64(1): 28–31.
    1. Janda V. Manuelle Muskelfunktionsdiagnostik. 4th ed. München; Jena: Urban & Fischer, 2000.
    1. Legro MW, Reiber GD, Smith DG, et al. Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. Arch Phys Med Rehabil 1998; 79(8): 931–938.
    1. Prosthetic Research Study. Prosthesis Evaluation Questionnaire. Seattle, WA: Prosthetics Research Study, 1998, pp. 1–21, (accessed 29 April 2013).
    1. Kannenberg A, Zacharias B, Mileusnic M. Activities of daily living: Genium Bionic Prosthetic knee compared with C-Leg. J Prosthet Orthot 2013; 25(3): 110–118.
    1. McMillan AG, Kendrick K, Michael JW, et al. Preliminary evidence for effectiveness of a stance control orthosis. J Prosthet Orthot 2004; 16(1): 6–13.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する