Abstract

With over 30 million people worldwide requiring assistive devices, there is a great need for low-cost and high-performance prosthetic technologies that can enable kinematics close to able-bodied gait. Low-income users of prosthetic knees in the developing world repeatedly report the need for n inconspicuous gait to mitigate the severe socioeconomic discrimination associated with disability. However, passive prosthetic knees designed for these users have primarily focused on stability and affordability, often at the cost of the high biomechanical performance that is required to replicate able-bodied kinematics. In this study, we present the design and preliminary testing of two distinct mechanism modules that are novel for passive prosthetic knee applications: the stability module and the damping module. These mechanisms are designed to enable users of single-axis, passive prosthetic knees to walk with close to able-bodied kinematics on level-ground, specifically during the transition from the stance phase to the swing phase of the gait cycle. The stability module was implemented with a latch mounted on a virtual axis of a four-bar linkage, which can be engaged during early stance for stability and disengaged during late stance to initiate knee flexion. The damping module was implemented with a concentric stack of stationary and rotating pairs of plates that shear thin films of high-viscosity silicone oil. The goal of the resulting first-order damping torque was to achieve smooth flexion of the prosthetic knee within the able-bodied gait range (64 ± 6 deg). For preliminary user-centric validation, a prototype prosthetic knee with the stability module and two different dampers (with varying damping coefficients) was tested on a single subject with above-knee amputation in India. The stability module enabled smooth transition from stance to swing with timely initiation of knee flexion. The dampers also performed satisfactorily, as the increase in the damping coefficient was found to decrease the peak knee flexion angle during swing. The applications of the mechanisms presented in this article could significantly improve the kinematic performance of low-cost, passive prosthetic knees.

References

1.
World Health Organization
,
2011
, "
World Report on Disability
",
World Health Organization
,
Geneva
,
Technical Report
.
2.
McDonald
,
C. L.
,
Westcott-McCoy
,
S.
,
Weaver
,
M. R.
,
Haagsma
,
J.
, and
Kartin
,
D.
,
2021
, “
Global Prevalence of Traumatic Non-Fatal Limb Amputation
,”
Prosthet. Orthot. Int.
,
45
(
2
), pp.
105
114
.
3.
World Health Organization
,
2017
, “
World Report on Disability: Standards for Prosthetics and Orthotics
,”
World Health Organization
,
Geneva
, Technical Report.
4.
Narang
,
Y. S.
,
2013
, “
Identification of Design Requirements for a High-Performance, Low-Cost, Passive Prosthetic Knee Through User Analysis and Dynamic Simulation
,” Master’s thesis,
Massachusetts Institute of Technology
,
Cambridge MA
.
5.
Narang
,
I. C.
,
Mathur
,
B. P.
,
Singh
,
P.
, and
Jape
,
V. S.
,
1984
, “
Functional Capabilities of Lower Limb Amputees.
,”
Prosthet. Orthot. Int.
,
8
(
1
), pp.
43
51
.
6.
Hamner
,
S. R.
,
Narayan
,
V. G.
, and
Donaldson
,
K. M.
,
2013
, “
Designing for Scale: Development of the ReMotion Knee for Global Emerging Markets
,”
Ann. Biomed. Eng.
,
41
(
9
), pp.
1851
1859
.
7.
Cummings
,
D.
,
1996
, “
Prosthetics in the Developing World: A Review of the Literature.
,”
Prosthet. Orthot. Int.
,
20
(
1
), pp.
51
60
.
8.
Andrysek
,
J.
,
2010
, “
Lower-Limb Prosthetic Technologies in the Developing World: A Review of Literature From 1994-2010
,”
Prosthet. Orthot. Int.
,
34
(
4
), pp.
378
398
.
9.
Mohan
,
D.
,
1967
, “
A Report on Amputees in India
,”
Orthot. Prosthet.
,
40
(
1
), pp.
16
32
.
10.
Horgan
,
O.
, and
MacLachlan
,
M.
,
2004
, “
Psychosocial Adjustment to Lower-Limb Amputation: A Review
,”
Disabil. Rehabil.
,
26
(
14–15
), pp.
837
850
.
11.
Rybarczyk
,
B.
,
Nyenhuis
,
D. L.
,
Nicholas
,
J. J.
,
Cash
,
S. M.
, and
Kaiser
,
J.
,
1995
, “
Body Image, Perceived Social Stigma, and the Prediction of Psychosocial Adjustment to Leg Amputation.
,”
Rehabil. Psychol.
,
40
(
2
), p.
95
.
12.
Winter
,
D. A.
,
1983
, “
Energy Generation and Absorption at the Ankle and Knee During Fast, Natural, and Slow Cadences
,”
Clin. Orthop. Relat. Res.
,
175
, pp.
147
154
.
13.
Narang
,
Y. S.
,
Arelekatti
,
V. M.
, and
Winter
,
A. G.
,
2016
, “
The Effects of Prosthesis Inertial Properties on Prosthetic Knee Moment and Hip Energetics Required to Achieve Able-Bodied Kinematics
,”
IEEE Trans. Neural Syst. Rehabil. Eng.
,
24
(
7
), pp.
754
763
.
14.
Narang
,
Y. S.
,
Arelekatti
,
V. M.
, and
Winter
,
A. G.
,
2016
, “
The Effects of the Inertial Properties of Above-Knee Prostheses on Optimal Stiffness, Damping, and Engagement Parameters of Passive Prosthetic Knees
,”
J. Biomech. Eng.
,
138
(
12
), p.
121002
.
15.
Murthy Arelekatti
,
V.
, and
Winter
,
A. G.
,
2018
, “
Design and Preliminary Field Validation of a Fully Passive Prosthetic Knee Mechanism for Users With Transfemoral Amputation in India
,”
ASME J. Mech. Rob.
,
10
(
3
), p.
031007
.
16.
Berringer
,
M. A.
,
Boehmcke
,
P. J.
,
Fischman
,
J. Z.
,
Huang
,
A. Y.
,
Joh
,
Y.
,
Warner
,
J. C.
,
Arelekatti
,
V. N. M.
,
Major
,
M. J.
, and
Winter
,
A. G.
,
2017
, “
Modular Design of a Passive, Low-Cost Prosthetic Knee Mechanism to Enable Able-Bodied Kinematics for Users With Transfemoral Amputation
,”
ASME 2017 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference
,
Cleveland, OH
,
Aug. 6–9
,
American Society of Mechanical Engineers
, p.
V05BT08A028
.
17.
Arelekatti
,
V. M.
, and
Winter
,
A. G.
,
2015
, “
Design of Mechanism and Preliminary Field Validation of Low-Cost, Passive Prosthetic Knee for Users With Transfemoral Amputation in India
,”
ASME 2015 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference
,
Boston, MA
,
Aug. 2–5
, American Society of Mechanical Engineers, p. V05AT08A043.
18.
Arelekatti
,
V. M.
, and
Winter
,
A. G.
,
2015
, “
Design of a Fully Passive Prosthetic Knee Mechanism for Transfemoral Amputees in India
,”
2015 IEEE International Conference on Rehabilitation Robotics (ICORR)
,
Singapore
,
Aug. 11–14
, IEEE, pp.
350
356
.
19.
Cavuto
,
M. L.
,
Chun
,
M.
,
Kelsall
,
N.
,
Baranov
,
K.
,
Durgin
,
K.
,
Zhou
,
M.
,
Arelekatti
,
V. M.
, and
Winter
,
A. G.
,
2016
, “
Design of Mechanism and Preliminary Field Validation of Low-Cost Transfemoral Rotator for Use in the Developing World
,”
ASME 2016 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference
,
Charlotte, NC
,
Aug. 21–24
, American Society of Mechanical Engineers, p. V05AT07A035.
20.
Gard
,
S. A.
,
2016
,
The Influence of Prosthetic Knee Joints on Gait
,
Springer International Publishing
,
Cham
, pp.
1
24
.
21.
Andrysek
,
J.
,
Klejman
,
S.
,
Torres-Moreno
,
R.
,
Heim
,
W.
,
Steinnagel
,
B.
, and
Glasford
,
S.
,
2011
, “
Mobility Function of a Prosthetic Knee Joint With An Automatic Stance Phase Lock
,”
Prosthet. Orthot. Int.
,
35
(
2
), pp.
163
170
.
22.
Winter
,
D. A.
,
2009
,
Biomechanics and Motor Control of Human Movement
, 4th ed,
John Wiley & Sons, Inc.
,
Hoboken, NJ
.
23.
Michael
,
J. W.
,
1999
, “
Modern Prosthetic Knee Mechanisms.
,”
Clin. Orthop. Relat. Res.
(
361
), pp.
39
47
.
24.
Radcliffe
,
C. W.
,
1994
, “
Four-Bar Linkage Prosthetic Knee Mechanisms: Kinematics, Alignment and Prescription Criteria
,”
Prosthet. Orthot. Int.
,
18
(
3
), pp.
159
173
.
25.
Wyss
,
D.
,
2012
, “
Evaluation and Design of a Globally Applicable Rear-Locking Prosthetic Knee Mechanism
,” Master’s thesis,
University of Toronto
,
Toronto, Canada
26.
Andrysek
,
J.
,
Naumann
,
S.
, and
Cleghorn
,
W. L.
,
2006
, “
Artificial Knee Joint
,” US Patent 7,087,090.
27.
Smith
,
D. G.
,
Michael
,
J. W.
, and
Bowker
,
J. H.
,
2004
,
Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles
, 3rd ed., Vol.
3
,
American Academy of Orthopaedic Surgeons Rosemont
,
IL
.
28.
Furse
,
A.
,
Cleghorn
,
W.
, and
Andrysek
,
J.
,
2011
, “
Development of a Low-Technology Prosthetic Swing-Phase Mechanism
,”
J. Med. Biol. Eng.
,
31
(
2
), pp.
145
150
.
29.
Johansson
,
J. L.
,
Sherrill
,
D. M.
,
Riley
,
P. O.
,
Bonato
,
P.
, and
Herr
,
H.
,
2005
, “
A Clinical Comparison of Variable-Damping and Mechanically Passive Prosthetic Knee Devices
,”
Am. J. Phys. Med. Rehabil.
,
84
(
8
), pp.
563
575
.
30.
Radcliffe
,
C. W.
,
1977
, “
The Knud Jansen Lecture: Above-Knee Prosthetics
,”
Prosthet. Orthot. Int.
,
1
(
3
), pp.
146
160
.
31.
Staros
,
A.
, and
Murphy
,
E. F.
,
1964
, “
Properties of Fluid Flow Applied to Above-Knee Prostheses
,”
J. Rehabil. Res. Dev.
,
50
(
3
), pp.
xvi
xvi
.
32.
Lewis
,
E. A.
,
1965
, “
Fluid Controlled Knee Mechanisms, Clinical Considerations
,”
Bull. Prosthet. Res.
,
10
(
3
), p.
24
.
33.
Budynas
,
R.
, and
Nisbett
,
K.
,
2010
,
Shigley’s Mechanical Engineering Design
, 9th ed.,
McGraw-Hill Science/Engineering/Math
,
New York
.
34.
Winter
,
D. A.
,
1991
,
The Biomechanics and Motor Control of Human Gait: Normal, Elderly, and Pathological
,
Waterloo Biomechanics
,
Waterloo, Canada
.
35.
Rumsey
,
R. D.
,
1969
, “
Tuned Viscous Vibration Dampers
,” Aug. 19, US Patent 3,462,136.
36.
Yazid
,
I. I. M.
,
Mazlan
,
S. A.
,
Kikuchi
,
T.
,
Zamzuri
,
H.
, and
Imaduddin
,
F.
,
2014
, “
Design of Magnetorheological Damper With a Combination of Shear and Squeeze Modes
,”
Mater. Des. (1980–2015)
,
54
, pp.
87
95
.
37.
Herr
,
H.
, and
Wilkenfeld
,
A.
,
2003
, “
User-Adaptive Control of a Magnetorheological Prosthetic Knee
,”
Ind. Rob.: Int. J.
,
30
(
1
), pp.
42
55
.
38.
White
,
F. M.
,
2016
,
Fluid Mechanics
,
McGraw-Hill
,
New York
.
39.
Hedrick
,
T. L.
,
2008
, “
Software Techniques for Two- and Three-Dimensional Kinematic Measurements of Biological and Biomimetic Systems
,”
Bioinspiration Biomimetics
,
3
(
3
), p.
034001
.
40.
Schmiechen
,
P.
, and
Slocum
,
A.
,
1996
, “
Analysis of Kinematic Systems: A Generalized Approach
,”
Precis. Eng.
,
19
(
1
), pp.
11
18
.
41.
Arelekatti
,
V. N. M.
,
Winter
,
A. G.
, and
Dorsch
,
D. S.
,
2018
, “
Passive Artificial Knee
,” US Patent App. 15/571, 027.
42.
Arelekatti
,
V. N. M.
,
Winter
,
A. G.
,
Fischman
,
J. Z.
,
Huang
,
A. Y.
, and
Joh
,
Y.
,
2018
, "
Locking and Damping Mechanism for a Prosthetic Knee Joint
",
US Patent App. 16/617,836
.
43.
Blumentritt
,
S.
,
Scherer
,
H. W.
,
Michael
,
J. W.
, and
Schmalz
,
T.
,
1998
, “
Transfemoral Amputees Walking on a Rotary Hydraulic Prosthetic Knee Mechanism: A Preliminary Report
,”
JPO: J. Prosthet. Orthot.
,
10
(
3
), pp.
61
70
.
44.
Mulholland
,
S. J.
, and
Wyss
,
U. P.
,
2001
, “
Activities of Daily Living in Non-Western Cultures: Range of Motion Requirements for Hip and Knee Joint Implants.
,”
Int. J. Rehabil. Res.
,
24
(
3
), pp.
191
198
.
45.
International Organization for Standardization
,
2006
, “
Structural Testing of Lower-Limb Prostheses: Requirements and Test Methods
,”
International Organization for Standardization
, Technical Report.
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