Hafner Brian J, Sanders Joan E, Czerniecki Joseph, Fergason John
Department of Bioengineering, University of Washington, Harris Hydraulics 309, Box 357962, Seattle 98195, USA.
Clin Biomech (Bristol). 2002 Jun;17(5):325-44. doi: 10.1016/s0268-0033(02)00020-7.
The development and prescription of energy storage and return prosthetic feet in favor of conventional feet is largely based upon prosthetist and amputee experience. Regretfully, the comparative biomechanical analysis of energy storage and return and conventional prosthetic feet is rarely a motivation to either the technical development or clinical prescription of such devices. The development and prescription of prosthetic feet without supportive scientific evidence is likely due to the conflicting or non-significant results often presented in the scientific literature. Despite the sizeable history of comparative prosthetic literature and continued analysis of prosthetic components, the link between clinical experience and scientific evidence remains largely unexplored.A review of the comparative analysis literature evaluating energy storage and return and conventional prosthetic feet is presented to illustrate consistencies between the perceptive assessments and the objective biomechanical data. Results suggest that while experimental methodologies may limit the statistical significance of objective gait analysis results, consistent trends in temporal, kinetic, and kinematic parameters correlate well with perceptive impressions of these feet. These correlations provide insight to subtle changes in gait parameters that are deemed neither clinically nor statistically significant, yet are perceived by amputees to affect their preference for and performance of prosthetic feet during locomotion. Acknowledging and targeting areas of perceptive significance will help researchers develop more structured protocols for energy storage and return prosthesis evaluation as well as provide clinicians with information needed to enhance the appropriateness of their clinical recommendations. Expanding test environments to measure activities of perceived improvement such as high-velocity motions, stair ascent/descent, and uneven ground locomotion will provide a more appropriate assessment of the conditions for which energy storage and return prosthetic feet were designed. Concentrating research to specific test populations by age or amputation etiologies can overcome statistical limitations imposed by small study samples. Finally, directing research toward the areas of gait adaptation, heel performance, and the temporal release of energy in energy storage and return feet may reinforce the selection and utilization of advanced prosthetic components. These enhancements to current biomechanical analyses may serve to reduce the boundaries of perceptive significance and provide clinicians, designers, and researchers with the supportive data needed to prescribe, design, and evaluate energy storage and return prosthetic feet.
与传统假脚相比，储能回能假脚的开发与处方更多是基于假肢师和截肢者的经验。遗憾的是，对储能回能假脚和传统假脚进行比较性生物力学分析，很少能推动此类装置的技术开发或临床应用。由于科学文献中常常呈现相互矛盾或不显著的结果，假脚的开发与处方缺乏有力的科学依据。尽管假肢比较文献历史悠久，且对假肢部件的分析仍在持续，但临床经验与科学证据之间的联系在很大程度上仍未得到探索。本文对评估储能回能假脚和传统假脚的比较分析文献进行综述，以阐明主观评估与客观生物力学数据之间的一致性。结果表明，虽然实验方法可能会限制客观步态分析结果的统计学意义，但时间、动力学和运动学参数的一致趋势与对这些假脚的主观印象高度相关。这些相关性有助于洞察步态参数的细微变化，这些变化在临床和统计学上均无显著意义，但截肢者认为会影响他们在行走过程中对假脚的偏好和使用表现。认识并关注具有主观意义的领域，将有助于研究人员制定更具系统性的储能回能假肢评估方案，并为临床医生提供所需信息，以提高其临床建议的合理性。拓展测试环境以测量诸如高速运动、上下楼梯和在不平地面行走等被认为有所改善的活动，将能更恰当地评估储能回能假脚的设计条件。按年龄或截肢病因将研究集中于特定测试人群，可克服小样本研究带来的统计限制。最后，针对步态适应性、足跟性能以及储能回能假脚的能量瞬时释放等领域开展研究，可能会加强对先进假肢部件的选择和应用。对当前生物力学分析的这些改进，或许有助于缩小主观意义的范围，并为临床医生、设计师和研究人员提供在开出处方、设计和评估储能回能假脚时所需的支持性数据。
