My Propitious Perusers,
I've spent this evening sitting in the NAU library developing the next logical post and here it is! I think it's important to talk about the different subjects used in this study so you have a better frame of reference as to who wears the prosthesis. We're going to first talk, though, about a bunch of device/subject-related material.
First, we'll look at some stats. Currently, of the 1.2 million transtibial amputees in the United States, only 40,000 are capable of wearing the BiOM. And of the 40,000 amputees having surgeries in the last year, only 16,000 are BiOM capable. To be "BiOM capable", an amputee most meet requirements of a mobility assessment. Which is measured through something called a k-value: a system that ranks your range of motion (ROM) on a scale of 1-4. An acceptable ROM is a 3 or 4, meaning the amputee is "good enough" at walking. Sometimes, a 2 is acceptable but this varies from case-to-case. Additionally, only 900 people in the United States currently use the BiOM, most of which are ex-military personnel. This is for various reasons, some include personal preference of an active vs. passive device but it's safe to assume the main reason is cost, especially because in most studies subjects find the active device more comfortable and efficient. The cost for one BiOM is between $50,000 and $75,000. Due to this huge investment, many studies (including ours) are often limited to only using one BiOM which means subjects don't have much time to become accustomed to the device, something I'll talk about when referencing individual subjects.
Now for specific subjects, each subject uses the same BiOM and their own personal prosthetic device. The BiOM is altered through computer mechanisms to meet different standards for each wearer. Their individual passive prostheses are energy-return systems (ERS), which gives very little energy return, making it passive. Using this device, it's likely their self-selected speeds will probably be slower. Here, we find the problem referenced earlier: study limitations. Because our subjects can't each receive a BiOM months in advance, they can't easily lose what are called compensation mechanisms. Compensation mechanisms are mechanisms the body uses to compensate for the lag of the prosthesis. By wearing a passive device for at least 1.5 years or more, our subjects are losing those mechanisms with their passive devices but are unable to lose those mechanisms with the BiOM. This is because with every testing session, each subject is granted only one hour of time to grow used to the BiOM. This has many consequences, the most important is that it changes their self-selected gait speeds. Simply, because subjects are less comfortable in the BiOM, their speeds slow in comparison to when using the ERS, especially in backward walking (we'll talk a lot more about backward walking and its implications in another post).
Our first subject, subject one (S1) had a mechanized injury, meaning they didn't lose their limb to cancer or another disease that may affect neurological communication. This subject lost their limb in bike accident when they were 18. In my last post, I referenced a subject who's worn a passive device longer than their original limb, this is that subject. And because of this, the subject is bothered by the faint buzzing made by the motor of the BiOM, which affects them too much for them to be satisfied with the device. It bothers S1 because it impairs their ability to conceal the device easily, making it an abnormality to S1, whereas they're already accustomed to the passive device's properties, believing that it is a "part of them". So, if they did wear it, their quality of life would be lowered.
Our second subject, subject two (S2) also had a mechanized injury after suffering through a car accident. S2 has worn their device for 1.5+ years. This subject does believe the BiOM is more capable than the passive prosthesis.
Our third subject, subject three (S3) also had a mechanized injury through a hunting accident. S3 has worn their passive device for 1.5+ years. Specifically, S3 believes the device increases functionality.
Now, you may be wondering how the BiOM attaches to the amputated leg, which happens in two ways: 1. a vacuum pump or 2. a sling. One of our subjects uses the vacuum pump, and feels that the device is a part of him, and no longer seems to be hanging on, which is what is typically felt by sling users (our other two subjects).
Hope that wasn't a touchy subject,
Pooja
P.S. I'm sorry for all of the bad puns in this post.
Monday, March 30, 2015
Week Six
Readers,
I'm sorry I didn't make this blogpost on Saturday, I couldn't attend the testing because I had to take an AP Euro mock exam ( :( ). But, I did have a marvelous meeting with my advisors today where we discussed A LOT of different topics. The testing was done with incredible speed, so they were able to gather heaps of data points (so exciting!). I've decided that in order to best explain everything we talked about and that occurred during testing, I'd make each topic its own post. Today, I think it'd be best to cover something that's necessary across the board for any type of human research, instead of something only specific to my own project--quality of life.
Quality of life can be determined by a lot of things. According to PubMed, it's defined as, "Considerable agreement exists that quality of life is multidimensional. Coverage may be categorised within five dimensions: physical wellbeing, material wellbeing, social wellbeing, emotional wellbeing, and development and activity." Often, we see a comparison of quality of life from country to country. For example, one might say that the quality of life is better in the United States than in Syria.
In some human research, quality of life means that the subject feels content with adjustments being made to them. My project, for example, tries to ensure that while using the BiOM, subjects don't feel any discomfort--mentally or physically. It also relies on agility, an ability to move quickly and with the same comfort and ease that a normal person would. To measure agility there are two common tests used: 1. the T-test and 2. the Up-and-Go test. The T-test has subjects walk first forward 10 meters, to the left 5 meters by sidestepping, to the right 10 meters by sidestepping, back left 5 meters (again sidestepping) and finally 10 meters backward to the starting position--forming a "T". The Up-and-Go test has subjects initially sitting down, then standing up, walking 10 meters, walking back, and sitting back down. This is a good measure of agility (and thus quality of life because they are able to perform quick yet simple walking movements) to use while testing the BiOM to ensure that the BiOM is not only performing well physically but creates ease and comfort for users. Remember, it's important to realize that even if the BiOM could function well under physical requirements, that doesn't matter unless the subject feels comfortable and satisfied with the device. For example, one of our subjects has worn a passive device for 10+ years (in fact he's had the prosthesis longer than he had a human lower limb) and feels mentally uncomfortable wearing the BiOM because it makes a small noise (due to the motor), whereas the passive device does not. This disturbs his quality of life.
Hope you found that interesting!
Pooja
I'm sorry I didn't make this blogpost on Saturday, I couldn't attend the testing because I had to take an AP Euro mock exam ( :( ). But, I did have a marvelous meeting with my advisors today where we discussed A LOT of different topics. The testing was done with incredible speed, so they were able to gather heaps of data points (so exciting!). I've decided that in order to best explain everything we talked about and that occurred during testing, I'd make each topic its own post. Today, I think it'd be best to cover something that's necessary across the board for any type of human research, instead of something only specific to my own project--quality of life.
Quality of life can be determined by a lot of things. According to PubMed, it's defined as, "Considerable agreement exists that quality of life is multidimensional. Coverage may be categorised within five dimensions: physical wellbeing, material wellbeing, social wellbeing, emotional wellbeing, and development and activity." Often, we see a comparison of quality of life from country to country. For example, one might say that the quality of life is better in the United States than in Syria.
In some human research, quality of life means that the subject feels content with adjustments being made to them. My project, for example, tries to ensure that while using the BiOM, subjects don't feel any discomfort--mentally or physically. It also relies on agility, an ability to move quickly and with the same comfort and ease that a normal person would. To measure agility there are two common tests used: 1. the T-test and 2. the Up-and-Go test. The T-test has subjects walk first forward 10 meters, to the left 5 meters by sidestepping, to the right 10 meters by sidestepping, back left 5 meters (again sidestepping) and finally 10 meters backward to the starting position--forming a "T". The Up-and-Go test has subjects initially sitting down, then standing up, walking 10 meters, walking back, and sitting back down. This is a good measure of agility (and thus quality of life because they are able to perform quick yet simple walking movements) to use while testing the BiOM to ensure that the BiOM is not only performing well physically but creates ease and comfort for users. Remember, it's important to realize that even if the BiOM could function well under physical requirements, that doesn't matter unless the subject feels comfortable and satisfied with the device. For example, one of our subjects has worn a passive device for 10+ years (in fact he's had the prosthesis longer than he had a human lower limb) and feels mentally uncomfortable wearing the BiOM because it makes a small noise (due to the motor), whereas the passive device does not. This disturbs his quality of life.
Hope you found that interesting!
Pooja
Tuesday, March 24, 2015
Week Five
Hello Readers!
Week five of my project has passed and I have one update. I will be officially testing with subjects this Saturday! In addition to being unbelievably eager to begin this step in my project, I'm very excited to apply my readings and everything I've learnt to practical scenarios.
I'm sorry I don't have more for you, but in the mean time please enjoy these pictures of a dog enjoying his first ever run with 3D-printed prosthetic legs.
Until Saturday,
Pooja
Week five of my project has passed and I have one update. I will be officially testing with subjects this Saturday! In addition to being unbelievably eager to begin this step in my project, I'm very excited to apply my readings and everything I've learnt to practical scenarios.
I'm sorry I don't have more for you, but in the mean time please enjoy these pictures of a dog enjoying his first ever run with 3D-printed prosthetic legs.
Until Saturday,
Pooja
Monday, March 23, 2015
Dun dun dun...
Hello Readers!
It's time we cover that daunting, merciless, and most unnerving topic. If you haven't guessed it yet, we're talking about engineering. But don't fret! I'll keep this simple (as far as simplicity goes) and to the point. Please refer to the picture of the BiOM below, the diagram which describe its components and the human ankle-foot system.
 |
| BiOM |
 |
| BiOM Components |
 |
| Human Foot + Muscles |
In the second picture on the diagram, we have the following: the motor spins the wheel closest to the right, which is hooked to a belt. This spinning, forces a motion in the belt, which, in turn, spins the left wheel. This left wheel is attached to a screw (the ball screw), this spinning then pushes downward on the heel, which pushes the series spring. But to counteract this motion, there is pull upwards on the parallel spring. This push and pull motion is to prevent the device from slamming down--it allows for more control. For example, when we walk, each push downward is managed and controlled, instead of slammed down. This is done by our body's force on the heel and the muscles at the front of our leg pulling up at the same time. The BiOM solves for this with a push on the series spring and a pull on the parallel spring.
I hope I made this as logical as one can make the inner mechanism of a motorized prosthetic device for you all!
Until next time,
Pooja
Saturday, March 21, 2015
Iron Man's Delivery
Readers!
It's official, I am in love with Iron Man. After years of watching the movies where a sassy Robert Downey Jr. helps/saves/and makes a mess out of the world, he's done it for real, well, he's done some of it for real. Almost 12 days ago, Tony Stark, as in the Tony Stark of Stark Industries presented 7-year old Alex with a 3D-printed Bionic arm.
Working with Albert Manero and Limbitless Solutions, RDJ presented this 7-year old, who was born with a right arm deformity, a working, prosthetic arm. Not only did the team bring a wild smile to Alex's face when he met Iron Man but they did so for only $350. Normally, these "robotic technologies" cost around $40,000. The team, though, in fact, donated the arm to Alex after pooling together their "coffee money" and saying "we were all bound to the belief that no one should profit from a child in need of an arm." This wonder was put together by The Collective Project, a team trying to empower great ideas. To learn more about the entire presentation, go here.
Though not a device for transtibial lower limb amputees, this and the ankle-foot device I work with are both targeted to achieve one very simple goal: helping people around the world.
It's official, I am in love with Iron Man. After years of watching the movies where a sassy Robert Downey Jr. helps/saves/and makes a mess out of the world, he's done it for real, well, he's done some of it for real. Almost 12 days ago, Tony Stark, as in the Tony Stark of Stark Industries presented 7-year old Alex with a 3D-printed Bionic arm.
 |
| Holy crap! |
Working with Albert Manero and Limbitless Solutions, RDJ presented this 7-year old, who was born with a right arm deformity, a working, prosthetic arm. Not only did the team bring a wild smile to Alex's face when he met Iron Man but they did so for only $350. Normally, these "robotic technologies" cost around $40,000. The team, though, in fact, donated the arm to Alex after pooling together their "coffee money" and saying "we were all bound to the belief that no one should profit from a child in need of an arm." This wonder was put together by The Collective Project, a team trying to empower great ideas. To learn more about the entire presentation, go here.
 |
| Alex's Arm |
Though not a device for transtibial lower limb amputees, this and the ankle-foot device I work with are both targeted to achieve one very simple goal: helping people around the world.
"You know, it's time like these when I realize what a superhero I am"
-Tony Stark
Tuesday, March 17, 2015
Prostheses: A History
Hello World!
I'm back and without any real project updates. Because subjects keep rescheduling with the NAU team, I'm still unable to start gathering data. So today I will give you a history of prosthetic devices. It may not seem so fun, but just wait.
Prosthetics go way back, farther than I had even imagined. In fact, in the time of the Punic Wars it's said that a Roman general lost his arm and had an iron one fashioned for himself to continue fighting. If you don't know the exact time period of the Punic Wars (which I don't expect you to), it's 264 BC-146 BC.
Advance a few (thousand) years and researchers have located what they believe to be the first preserved artificial body part--a mummified prosthetic toe made from wood and leather. The toe belonged to an Egyptian noblewoman who's been preserved for nearly 3,000 years! Sure, wood and leather don't compare to a motor and cast, but they lay a groundwork for years of prosthetics ahead.
Post mummified Egyptians, we see major advances in prosthetics in 16th century France. In fact, the advancements made during this time are still widely used in the prosthetics today. Military doctor, Ambroise Paré, developed hinging hands and legs that could lock at the knee alongside harness attachments. After his work, a Dutch surgeon, Pieter Verduyn, developed a lower leg prosthesis with specialized hinges.
By 1812, a prosthetic arm was developed which could be controlled by the opposite shoulder through multiple different straps. Later in the 1800s, the creation of gaseous anesthesia allowed for more precise and careful surgeries. Additionally, due to better and more hygienic conditions, surgeries had a much higher success rate, which in turn, increased demand for prostheses. This demand continued to increase into the 20th century for various reasons (like WWII) until the National Academy of Sciences developed the Artificial Limb Program in 1945.
Give it 70 years and we're at modern day prosthetics. Which have become wildly more advanced. In an article from Gear Patrol, Amos Kwon and Ben Bowers explain these advancements through one man's story, and no, it's not the already mass publicized story of Oscar Pistorious, "In the case of Sergeant 1st Class Leroy Petry, recipient of the Congressional Medal of Honor, a biomechanical hand allowed him to rejoin the Army Rangers. Sensors in the prosthetic forearm and hand pick up electro-muscular signals which would normally cue his own hand to move, giving him an intermediate level of dexterity that mimics basic hand movements."
I hope you found this history as interesting as I did.
Until next time,
Pooja
I'm back and without any real project updates. Because subjects keep rescheduling with the NAU team, I'm still unable to start gathering data. So today I will give you a history of prosthetic devices. It may not seem so fun, but just wait.
Prosthetics go way back, farther than I had even imagined. In fact, in the time of the Punic Wars it's said that a Roman general lost his arm and had an iron one fashioned for himself to continue fighting. If you don't know the exact time period of the Punic Wars (which I don't expect you to), it's 264 BC-146 BC.
Advance a few (thousand) years and researchers have located what they believe to be the first preserved artificial body part--a mummified prosthetic toe made from wood and leather. The toe belonged to an Egyptian noblewoman who's been preserved for nearly 3,000 years! Sure, wood and leather don't compare to a motor and cast, but they lay a groundwork for years of prosthetics ahead.
 |
| The toe! |
Post mummified Egyptians, we see major advances in prosthetics in 16th century France. In fact, the advancements made during this time are still widely used in the prosthetics today. Military doctor, Ambroise Paré, developed hinging hands and legs that could lock at the knee alongside harness attachments. After his work, a Dutch surgeon, Pieter Verduyn, developed a lower leg prosthesis with specialized hinges.
By 1812, a prosthetic arm was developed which could be controlled by the opposite shoulder through multiple different straps. Later in the 1800s, the creation of gaseous anesthesia allowed for more precise and careful surgeries. Additionally, due to better and more hygienic conditions, surgeries had a much higher success rate, which in turn, increased demand for prostheses. This demand continued to increase into the 20th century for various reasons (like WWII) until the National Academy of Sciences developed the Artificial Limb Program in 1945.
 |
| The shoulder-arm attachment |
Give it 70 years and we're at modern day prosthetics. Which have become wildly more advanced. In an article from Gear Patrol, Amos Kwon and Ben Bowers explain these advancements through one man's story, and no, it's not the already mass publicized story of Oscar Pistorious, "In the case of Sergeant 1st Class Leroy Petry, recipient of the Congressional Medal of Honor, a biomechanical hand allowed him to rejoin the Army Rangers. Sensors in the prosthetic forearm and hand pick up electro-muscular signals which would normally cue his own hand to move, giving him an intermediate level of dexterity that mimics basic hand movements."
 |
| Leroy Petry and his bionic hand! |
I hope you found this history as interesting as I did.
Until next time,
Pooja
Monday, March 9, 2015
Week Four
Welcome back!
In the past week, I haven't had much experience with walking or the BiOM, sadly. My week was instead riddled with House Of Cards and popcorn. Though, I do have some good news-- I was officially granted IRB (Institutional Review Board) approval to work with human subjects! Testing hasn't begun quite yet due to rescheduling conflicts but by May 18th I will have a full set of crunched numbers ready to present. Prior to testing, I will continue reading, reading and... reading.
Some of the reading I've already done, includes this article, which expands bionic technology beyond the scope of the prosthetic devices. It considers everything from text messaging to sensory feeling in synthetic limbs. Not only did reading this allow me to better understand the background of prostheses but it gave me better perspective on these developing technologies and how they influence everything around us. Development in these fields doesn't only indicate hope for enhanced walking (amputee or not) but it shows hope for enhanced communication or even military infrastructure. In fact, the Department of Defense has funded a project which develops a device to be worn in unison with fully functional limbs to give soldiers a faster running speed--the four minute mile.
Anyway, I hope you enjoy the article and are also able to consider the widely received benefits from this developing industry. Hopefully, by my next post I will be able to tell you how my first day of testing has gone.
"I cannot abide falling back to square one"
--Frank Underwood
In the past week, I haven't had much experience with walking or the BiOM, sadly. My week was instead riddled with House Of Cards and popcorn. Though, I do have some good news-- I was officially granted IRB (Institutional Review Board) approval to work with human subjects! Testing hasn't begun quite yet due to rescheduling conflicts but by May 18th I will have a full set of crunched numbers ready to present. Prior to testing, I will continue reading, reading and... reading.
Some of the reading I've already done, includes this article, which expands bionic technology beyond the scope of the prosthetic devices. It considers everything from text messaging to sensory feeling in synthetic limbs. Not only did reading this allow me to better understand the background of prostheses but it gave me better perspective on these developing technologies and how they influence everything around us. Development in these fields doesn't only indicate hope for enhanced walking (amputee or not) but it shows hope for enhanced communication or even military infrastructure. In fact, the Department of Defense has funded a project which develops a device to be worn in unison with fully functional limbs to give soldiers a faster running speed--the four minute mile.
Anyway, I hope you enjoy the article and are also able to consider the widely received benefits from this developing industry. Hopefully, by my next post I will be able to tell you how my first day of testing has gone.
"I cannot abide falling back to square one"
--Frank Underwood
Monday, March 2, 2015
Week Three
Hello Readers!
I post this with exciting news--I have found four of my own "subjects" to walk backwards for me so I can develop a better understanding of backwards walking! Today, I will show you how these human steps work in a more specific sense than "step back, step forward". My four walkers, S1, S2, S3, and S4 are all incredibly athletic and have had zero past issues with any lower limbs. They also didn't know for what reason they were being asked to walk backwards, so as to eliminate any strange movements they may have had otherwise. Here, I will show you the pictures of one walker with descriptions of each movement.
1. This is the first initial step back. Here, the subject's left foot is stationary while the right one lifts up before moving back, this is called controlled dorsiflexion.
2. Following the previous step, the subject has moved her right foot back and touched her toes down to the ground before setting her entire foot flat. This step is called controlled plantar-flexion. Controlled, in this context, means that the walker is able to control their foot's movement, so instead of the foot slamming onto the ground, it is controlled and moved carefully down. Often, people with walking disabilities don't have this control, which is why you see their steps as heavy and slammed.
3. Next, as the right foot touches down, her left foot begins to move upward with her heel as the "pivot point", which develops a torque. This is where we see physical properties being able to relate to a biologically inspired prosthesis. Again, this movement is called dorsiflexion.
4. Finally, the step is finished when the subject brings her left foot back and touches her toe to the ground. This movement is called controlled plantar-flexion.
In each of these moments, we see that most of the muscles tensed are in her calf muscles and quadriceps rather than the muscles of the ankle, which are only tensed when the subject is raising or lowering her foot, dorsiflexion and plantar-flexion, respectively. Whereas, in forwards walking, the calves and quads are much less often tensed. This difference in movement between backward walking and forward walking is one reason it's important to test for backward walking.
My apologies if this post makes you pay a little too much attention to how you walk. After starting this project, I find myself quite often noticing the gait of those around me.
Until next time,
Pooja
I post this with exciting news--I have found four of my own "subjects" to walk backwards for me so I can develop a better understanding of backwards walking! Today, I will show you how these human steps work in a more specific sense than "step back, step forward". My four walkers, S1, S2, S3, and S4 are all incredibly athletic and have had zero past issues with any lower limbs. They also didn't know for what reason they were being asked to walk backwards, so as to eliminate any strange movements they may have had otherwise. Here, I will show you the pictures of one walker with descriptions of each movement.
1. This is the first initial step back. Here, the subject's left foot is stationary while the right one lifts up before moving back, this is called controlled dorsiflexion.
2. Following the previous step, the subject has moved her right foot back and touched her toes down to the ground before setting her entire foot flat. This step is called controlled plantar-flexion. Controlled, in this context, means that the walker is able to control their foot's movement, so instead of the foot slamming onto the ground, it is controlled and moved carefully down. Often, people with walking disabilities don't have this control, which is why you see their steps as heavy and slammed.
3. Next, as the right foot touches down, her left foot begins to move upward with her heel as the "pivot point", which develops a torque. This is where we see physical properties being able to relate to a biologically inspired prosthesis. Again, this movement is called dorsiflexion.
4. Finally, the step is finished when the subject brings her left foot back and touches her toe to the ground. This movement is called controlled plantar-flexion.
In each of these moments, we see that most of the muscles tensed are in her calf muscles and quadriceps rather than the muscles of the ankle, which are only tensed when the subject is raising or lowering her foot, dorsiflexion and plantar-flexion, respectively. Whereas, in forwards walking, the calves and quads are much less often tensed. This difference in movement between backward walking and forward walking is one reason it's important to test for backward walking.
My apologies if this post makes you pay a little too much attention to how you walk. After starting this project, I find myself quite often noticing the gait of those around me.
Until next time,
Pooja
Subscribe to:
Posts (Atom)