You must create a final paper for my proposal. I will provide a rubric along with my methodology, literature review, background/rational, background studies, and abstract.
Methodology
Yousef Rashad
Dr. Dodd
SXU
EXSC390
Methodology
Research Design
Informed by the nature of the research problem, this study proposes a mixed methods
approach to investigate the impact of incorporation cognitive therapy (mindset incorporation)
during physical rehabilitative therapy on the patient’s locomotor adaptability and biomechanical
efficiency post installation of Transtibial prostheses. The study will thus adopt a correlational
research design to explore the relationship between incorporation of cognitive techniques in
physical rehabilitative therapy and the success of therapy in regards to the restoration of
biomechanical efficiency and the acquisition of locomotor adaptability. A positive correlation
between the variables will thus prove the hypothesis that cognitive therapy (mindset
incorporation) strategies increase the success of biomechanical efficiency and locomotor
adaptability post amputation and vice versa.
Study Settings
This research will primarily involve an online dimension whereby the collection of data
and correspondence via researchers and participants shall be conducted digitally.
Data Collection & Data type
This research will explore to what degree cognitive therapy (mindset incorporation)
influences efficacy of rehabilitative therapy post Transtibial amputation and consequent
prosthesis installation. The research will therefore seek to collect and analyze both quantitative
and qualitative data on the restoration of biomechanical efficiency and the acquisition of
locomotor adaptability among Transtibial amputees during post amputation rehabilitative
therapy.
This research will rely on the collection and analysis of both primary and secondary data
to realize its stated objectives. Primary data will be collected through the administration of
questionnaires to patients and therapists who fit the inclusion criteria. For secondary data,
records from physical therapy clinics that have adopted cognitive therapy (mindset
incorporation) techniques in rehabilitative therapy for Transtibial amputees will be collected and
analyzed. Findings from existing parallel research will also be incorporated into the study.
Data Analysis
The collected data shall be documented, organized, analyzed and interpreted to
substantiate conclusions of the research. To interpret qualitative data, narrative and grounded
theory analysis techniques shall be incorporated in synthesis. Quantitative data shall be
organized into charts and the requisite data points such as measures of central tendency
computed for comparative synthesis and interpretation. Based on the computations, the research
will determine correlation between the independent variable (therapy approach) and dependent
variable (efficiency of biomechanical and locomotor adaptability post-amputation).
Budget
Owing to the lack of funding for this research, the budget for the study is constrained.
The study thus proposes inexpensive techniques and approaches to realize its objectives. All
participants in this research will contribute to the research on a voluntary basis and shall not be
compensated.
Ethical Considerations
The appropriate permits from relevant institutions shall be sought. Participation in this
research will be on a voluntary basis, where all subjects shall be adequately informed of the
objectives and scope of research and their consent sought. The research also endeavors to uphold
the confidentiality of data collected pursuant to the research objectives. Data collected within this
research shall not be appropriated outside the scope of this research.
1|Page
BACKGROUND STUDIES
1. Cherni, Y., Laurendeau, S., Robert, M., & Tircot, K. (2022). The Influence of Transtibial
Prosthesis Type on Lower-Body Gait Adaptation: A Case Study. International Journal of
Environmental Research and Respiratory Public Health, 20(1).
doi:10.3390/ijerph20010439.
2. Darter, B., Bastian, A., Wolf, E., Husson, E., Labrecque, B., & Hendershot, B. (2017).
Locomotor adaptability in persons with unilateral transtibial amputation. PLoS ONE, 12(7).
Retrieved from https://doi.org/10.1371/journal.pone.0181120
3. Hashimoto, H., Kobayashi, T., Gao, F., & Kataoka, M. (2023). A proper sequence of
dynamic alignment in transtibial prosthesis: insight through socket reaction moments.
Scientific Reports, 13(458). doi:10.1038/s41598-023-27438-1
4. Hill, S., Patla, A., Ishac, M., Adkin, A., & Barth, D. (2019). Altered kinetic strategy for the
control of swing limb elevation over obstacles in unilateral below-knee amputee gait.
Journal of Biomechanics, 32(5), 545-549. doi:10.1016/s0021-9290(98)00168-7
5. Nolasco, L., Silverman, A., & Gates, D. (2023). Transtibial prosthetic alignment has small
effects on whole-body angular momentum during functional tasks. Journal of
Biomechanics, 149. doi:10.1016/j.jbiomech.2023
1
Abstract
The loss of a body limb through illness or injury results in loss of locomotor ability for the
victim. To counteract this, the field of medicine has over time resulted to replacing the
affected organ with artificially made organs (prostheses) to restore lost function and
appearance. This branch of medicine is referred to as prosthetics and has over time evolved
from rudimentary prosthesis options with limited restorative impact to highly advanced
options geared towards full restoration of natural function of the involved organ. This has
been facilitated by various advancements in various relevant fields such as 3D printing for
prototyping, neuroscience and even biomechanics!
The field of kinesiology has long been involved in the advanced study of biomechanics of
the human body, exploring how the anatomical structure of the body facilitates natural
movement patterns. This knowledge has therefore been extrapolated in medicine within
the branch of prosthetics to predictively improve the rehabilitative and restorative
function of prostheses. As such, the aim of this research will be to determine how the
incorporation of kinesiology and biomechanics in prostheses has impacted the field of
prosthetics. Specifically, the research will investigate qualitative impact of restoration of
locomotor efficiency achieved through application of advanced prostheses developed
through detailed analysis of biomechanics in kinesiology. A meta-analysis of current
scientific literature on the subject matter will thus be performed to this end. The metaanalysis will include relevant clinical trials, scientific reviews, randomized controlled trials
(R.C.T), systematic review articles. The findings of this research will thus help to gauge and
inform the trajectory of application of kinesiology principles in the development of
prostheses.
Specific aims
RESEARCH QUESTIONS
(I)
What are the latest advancements in prosthetic development?
(II)
How has the discipline of kinesiology and biomechanics impacted the development of
prostheses?
(III)
How do current advancements help to circumvent locomotor adaptability deficits
associated with older generations of prostheses?
(IV) What are the qualitative and quantitative(time-based) differences between locomotor
adaptability between previous rudimentary prostheses and current advanced
prostheses?
Overall Aim: To determine the qualitative impact of restoration of locomotor efficiency
achieved through application of advanced prostheses developed through detailed analysis
of biomechanics in kinesiology.
BACKGROUND
The loss of a limb necessitates its replacement, often with an artificial option known as a
prosthesis. The science of developing such artificial body organs to replace lost ones is known as
prosthetics. Overall, the primary goal of prosthesis installation is to allow the patient to regain
the function of the affected limb. However, the degree to which this restorative function is
achieved varies based on various parameters. For instance, modern advanced prosthetic options
have far greater restorative impact compared to millennial, rudimentary options. As such, the
field of prosthetics continually innovates towards perfecting prosthesis development to ensure
amputees regain near-natural functionality of the affected limb. To this end, knowledge in
kinesiology, particularly on biomechanics and kinematics of the human body has become an
integral dimension of prosthetics. This knowledge is integrated at various levels within
prosthetics such as the development of morphologically accurate prostheses, translational
prosthesis-socket alignments, and kinetic adaptation strategies to improve efficiencies in the
restorative function of prostheses. Consequently, there is an ever-growing body of scientific
literature exploring various dimensions of the intersectionality of kinesiology and prosthesis
shedding light on the topic and justifying further research into the subject.
The relationship between the prosthesis and the socket affects its restorative functionality
in various dimensions including stability, comfort, kinetics and kinematics. This relationship is
determined by both the morphological accuracy of the prosthesis as well as its placement within
the socket. As such, among the greatest determinants of the efficacy of prosthesis restoration lies
in accurate mapping and artificial replication of the anatomical structure of the affected limb
while developing the prosthesis. This ensures that the translation of moments to the prosthesis
from the adjoining socket resembles a normal anatomical case scenario hence fewer limitations
on the biomechanics of the limb such as angular momentum trunk range of motion and peak
ground reaction forces (Nolasco, Silverman, & Gates, 2023). Therefore, prosthesis types greatly
affect the desired efficacy whereby different types and models of prosthesis will result in varying
degrees of propulsive force, moments etc. (Cherni, Laurendeau, Robert, & Tircot, 2022). As
such, the prescription of an appropriate prosthesis type is critical in ensuring the patient regains
their limb function.
Beyond accurate replication, there is also a need to ensure correct alignment (spatial
relationship) between the socket and adjoining prosthesis as this greatly affects balance and gait
depending on socket reaction moments (Hashimoto, Kobayashi, Gao, & Kataoka, 2023). This is
achieved by determining the optimal placement adjustment of the prosthesis within the prosthetic
socket. There are various types of alignments including stump, bench, static, and dynamic. More
so, depending on the location, there are various anatomical planes along which the prosthesis
may be aligned such as sagittal and coronal planes. On this end, existing scientific literature
recommends that a gait analysis be performed to inform the most effective alignment strategy.
For instance, Hashimoto, Kobayashi, Gao, & Kataoka, (2023) conducted a study indicating that
alignment of Transtibial prostheses in the coronal plane has the most benefit for locomotor
adaptability post-amputation. The results of this study lay reliable grounds for the conclusion that
optimal placement of the prosthesis in relation to the adjoining socket is imperative in attaining
the maximum restorative capacity of a prosthetic option.
The installation of prostheses also results in a need for rehabilitative adaptation to regain
locomotor efficiency. To regain their motor skills post-amputation, amputees need to engage in
rehabilitative therapy to gradually accommodate the prosthesis. During this process, amputees
will normally demonstrate characteristic kinetic adaptation strategies. This is especially evident
during the completion of strenuous tasks such as limb elevation and lowering to accommodate
for dynamic balance. This has been fairly investigated in previous research with findings
suggesting inverse kinetic accommodation strategies. In their study, Hill, Patla, Ishac, Adkin, &
Barth, (2019), conclude that with the appropriate design of prostheses, the CNS is over time able
to incorporate locomotor adaptability to modify motion as appropriate to avert potential
instability. Darter, et al., (2017) also illustrate that current advancements in transtibial prosthesis
have enabled near-natural locomotor adaptability during reactive accommodations and deadaptive responses in persons with TTA hence improving the restorative function of prostheses.
Beyond the physical aspect of kinetic adaptation, the mind-body interaction of this process is
critical in regaining locomotor efficiency, yet there is a critical dearth of research on this end. For
effective attainment of locomotor efficiency post-amputation, amputees must exercise
coordination of the mind and affected limb. This allows for more effective, natural-like
adaptability when regaining the function of the limb.
THEORETICAL RATIONALE
Among limb prosthetic patients, the goal is to regain a full range of locomotor and
biomechanical efficiency as though the patient were still operating on their natural limb. Existing
research has already delved into this subject exploring various dimensions for improving the
restorative capacity of prosthesis by relying on knowledge from kinesiology. One of these has
been in rehabilitative adaptability whereby research has thus far been centered on kinetic
adaptation. Mindset incorporation is a major part of successful adaptive rehabilitation but this is
yet to be fully researched in the realm of prosthetic adaptation. Therefore, should scientific
studies unearth new insights for holistic mind-body intervention during post-amputation
rehabilitation, the field of prosthetics would be better placed to achieve better locomotor and
biomechanical efficiency.
References
Cherni, Y., Laurendeau, S., Robert, M., & Tircot, K. (2022). The Influence of Transtibial
Prosthesis Type on Lower-Body Gait Adaptation: A Case Study. International Journal of
Environmental Research and Respiratory Public Health, 20(1).
doi:10.3390/ijerph20010439.
Darter, B., Bastian, A., Wolf, E., Husson, E., Labrecque, B., & Hendershot, B. (2017).
Locomotor adaptability in persons with unilateral transtibial amputation. PLoS ONE,
12(7). Retrieved from https://doi.org/10.1371/journal.pone.0181120
Hashimoto, H., Kobayashi, T., Gao, F., & Kataoka, M. (2023). A proper sequence of dynamic
alignment in transtibial prosthesis: insight through socket reaction moments. Scientific
Reports, 13(458). doi:10.1038/s41598-023-27438-1
Hill, S., Patla, A., Ishac, M., Adkin, A., & Barth, D. (2019). Altered kinetic strategy for the
control of swing limb elevation over obstacles in unilateral below-knee amputee gait.
Journal of Biomechanics, 32(5), 545-549. doi:10.1016/s0021-9290(98)00168-7
Nolasco, L., Silverman, A., & Gates, D. (2023). Transtibial prosthetic alignment has small
effects on whole-body angular momentum during functional tasks. Journal of
Biomechanics, 149. doi:10.1016/j.jbiomech.2023
1
LITERATURE REVIEW
Prosthetic Design and Selection
The field of prosthetics has witnessed revolutionary advancements particularly in the
dimension of prosthesis design. From anatomical realism/accuracy to improved materials,
current generations of prosthetics are greatly advanced rendering them more efficient in the
restoration of limb functionality. For instance, anatomical realism is integral in optimizing
alignment which highly correlates with capacity for locomotor adaptability. Additionally, better
materials such as titanium and aluminium have allowed more lightweight prosthesis which
reduce the pressure during locomotor adaptations. Beyond innovative design, the selection of the
optimal prosthetic option also greatly correlates with the efficiency of restorative function. To
this end, researchers have investigated various types of prostheses for varying scenarios. For
instance, Cherni, Laurendeau, Robert, & Tircot (2022) conduct a case study to determine the
impact on gait adaptation resulting from Transtibial prosthesis types. For their study, the
researchers compare different Transtibial prosthetic options: Variflex, Meridium, Echelon, and
Kinterra. The corresponding kinematic and kinetic parameters for all four prosthetic options are
then analyzed by simulating various common biomechanical movements. The findings of the
study portray varying degrees of propulsive force, knee extension moment, knee abduction
moment and lower support moments. The study thus presents the conclusion that it is paramount
to conduct objective gait analysis to determine the type of prostheses to prescribe to a patient for
maximum fit. The choice of prosthetic should thus not only be informed by anatomical accuracy
or material which is likely to generate a one-size-fits-all scenario. Rather, it should also take into
account the patient’s unique requirements for optimal efficiency.
2
Locomotor Adaptability
One of the key areas for advancement in prosthetics has been locomotor adaptability
post-amputation and installation of prosthetics. In technical terms, locomotor adaptability refers
to an error-driven spatiotemporal motor learning process. Basically, this pertains to modified
mannerisms and compensation strategies in gait and motion typically observed with amputees in
learning to accommodate the prosthetic limb to the body’s physiological functioning. Generally,
the necessity of locomotor adaptability is often amplified in more technical tasks such as obstacle
avoidance, walking and limb elevation and less perceptible in terms of gait. In an observational
study, Houdjik, et al., (2012) demonstrate that there is negligible between amputees and controls
in gait adaptability but the differences are more profound in locomotor adaptability. This renders
locomotor adaptability an integral area in the field of prosthetics. Thus far, scientific research
into this dimension has observed that current generations of prosthetics have enabled better
locomotor adaptability post-prosthesis installation.
Darter, et al. (2017) investigate the efficacy of locomotor adaptability in patients with
unilateral Transtibial Amputation (TTA). The researchers designed an experiment involving 10
TTA amputees and a control group of 8 non-amputees engaging in designated physical activities.
The researchers evaluate differences in exercise-induced reactive accommodations and deadaptive responses between the two groups. There are negligible differences in both reactive
accommodations and de-adaptive responses between both groups. The findings of the study thus
conclude that advances in prosthetics have enabled near-natural locomotor adaptability in
persons with TTA. In a similar study, Hill, Patla, Ishac, Adkin, & Barth, (2019) set out to
investigate the alteration of kinetic strategies for the control limbs during obstacle elevation
among below-knee prosthetic patients. For the study, kinematic data during limb elevation and
3
lowering is collected as subjects step over obstacles of varying height along a walking path. The
findings indicated that to allow limb elevation and lowering, accommodations involved inversing
kinetic strategy such that on the amputated side greater work modulation was done at the hip and
not the knee, contrary to the sound side. The study thus concludes that with the appropriate
design of prostheses, the CNS is over time able to incorporate locomotor adaptability to modify
motion as appropriate to avert potential instability.
The achievement of better locomotor adaptability among amputees can be attributed to
advances in prosthetics in inducing and restoring somatosensation. In their paper, Daekyoo,
Triolo, & Charkhkar (2023) note that using implanted neural intafaces in restoring senstations
perceived as original directly from the prosthesis was effective in gait and locomotor
adaptability. Further, their paper demonstrates that restored plantar sensation improves gait
symmetry, and enhances stance time and propulsive force generated from the prosthetic side.
The results of this study thus unequivocally demonstrate that induced restorative
somatosensation is an integral dimension of prosthetics in achieving better locomotor
adaptability.
Alignment
To achieve the restorative intent of prostheses, one of the critical factors determining the
efficacy of such restoration is prosthesis alignment during installation. This pertains to attaining
the optimal placement of the prosthetic on the socket such that it generates the least pressure for
accommodation into physiological functioning. Alignment has been extensively studied in
clinical practice with the aim of enhancing efficiency of prostheses. Nolasco, Silverman, &
4
Gates, (2023) investigate the impact of Transtibial prosthetic alignment on body momentum
during functional tasks such as walking, sit-to-stand and stand-to-sit. The researchers designed
an experiment involving different tasks and compared angular momentum, trunk range of motion
and peak ground reaction forces between 10 amputees and 10 non-amputees. The findings
demonstrate that alignment modulates the range of angular momentum during functional tasks
such as walking. The researchers thus conclude that TTA patients can adapt to small translational
alignment changes to maintain dynamic balance during functional tasks. In a similar research,
Hashimoto, Kobayashi, Gao, & Kataoka, (2023) demonstrate the importance of dynamic,
kinesiology-informed alignment in Transtibial prostheses and prescribe a proper sequence based
on socket reaction moments. Ordinarily, TTA patients face balance difficulties during functional
tasks but prosthetic alignment can help correct this limitation. However, it is imperative that the
alignment process be tuned to the optimal spatial relationship of translational planes to achieve
optimal biomechanical capacity. The researchers designed an experiment where Transtibial
amputees walk in different alignment conditions and measured moment changes in the coronal
and sagittal planes. The results of the study demonstrated alignments in all three planes modulate
moment changes in the coronal plane while those of the sagittal plane are only affected by
sagittal alignment changes. The authors thus conclude that prosthesis alignments should be
finalized in the coronal plane.
5
References
Cherni, Y., Laurendeau, S., Robert, M., & Tircot, K. (2022). The Influence of Transtibial Prosthesis Type on
Lower-Body Gait Adaptation: A Case Study. International Journal of Environmental Research and
Respiratory Public Health, 20(1). doi:10.3390/ijerph20010439.
Daekyoo, K., Triolo, R., & Charkhkar. (2023). Restored somatosensation in individuals with lower limb
loss improves gait, speed perception, and motor adaptation. Science Robotics, 1-25.
Darter, B., Bastian, A., Wolf, E., Husson, E., Labrecque, B., & Hendershot, B. (2017). Locomotor
adaptability in persons with unilateral transtibial amputation. PLoS ONE, 12(7). Retrieved from
https://doi.org/10.1371/journal.pone.0181120
Hashimoto, H., Kobayashi, T., Gao, F., & Kataoka, M. (2023). A proper sequence of dynamic alignment in
transtibial prosthesis: insight through socket reaction moments. Scientific Reports, 13(458).
doi:10.1038/s41598-023-27438-1
Hill, S., Patla, A., Ishac, M., Adkin, A., & Barth, D. (2019). Altered kinetic strategy for the control of swing
limb elevation over obstacles in unilateral below-knee amputee gait. Journal of Biomechanics,
32(5), 545-549. doi:10.1016/s0021-9290(98)00168-7
Houdjik, H., Ooijen, M., Kraal, J., Wiggerts, H., Polomski, W., Janssen, T., & Roerdink, M. (2012).
Assessing Gait Adaptability in People With a Unilateral Amputation on an Instrumented
Treadmill With a Projected Visual Context. Physical Therapy, 92(11), 1452-1460. Retrieved from
https://doi.org/10.2522/ptj.20110362
Nolasco, L., Silverman, A., & Gates, D. (2023). Transtibial prosthetic alignment has small effects on
whole-body angular momentum during functional tasks. Journal of Biomechanics, 149.
doi:10.1016/j.jbiomech.2023
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