Professional Documents
Culture Documents
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* Consent is is a bit of a misnomer as I had to choose between 1) hip-disarticulation or 2) slowly dying from infection or 3) slowly dying from the I.V. Vancomycin (antibiotic of last resort) eating my body away.
PROSTHETICS
• I am not an athlete (165lbs/5’11”), and certainly not young (52+),
yet…..
• I am a full-time user AND I walk without a cane and…
• I live a full life and do just about everything I want.
• Granted, there are some limitations. Yes, I can’t play tennis anymore.
Big deal! Yes, I can’t ride motorcycles anymore. That, I do miss indeed
but it’s not the end of the world.
• Is the prosthesis comfortable? Hell no! But it beats using crutches all
day.
• Biggest problem with using crutches is that we loose the use of our
hands. People are always surprised when I say this. What I mean is
that we cannot carry things easily when using crutches.
PROSTHETICS
• The key to success is to become deeply involved in the process.
• It is easy to believe that “This is as best as it can be!”. These highly trained professional
prosthetists have done their best but I still can’t walk with the damn’ leg. It hurts, I keep
on falling (This I did. 3 broken wrists, 1 rib…). Therefore, I must be the problem. I am not
just good enough. I am too old. I am not trying hard enough. I am too weak, etc…
• True! This highly trained professionals try hard but…
• They lack experience in this domain.
• They don’t have the time to do it right and,
• These types of prosthetic legs are finicky to set up. It takes days of incremental
adjustments to get it just right. (i.e. Efficient to use (not tiring) and stable)
• For example, on my current leg, there are 44 set-screws and other
adjustments, all interacting with each other, altering the geometry and other
parameters of the leg.
PROSTHETICS - SOCKET
• The first socket was a disaster. Eventually, my prosthetist relented and accepted to build a second
one at no cost. Including many modifications I had suggested during numerous discussions.
• This socket is much better but by no mean GOOD.
• From what I have read in several technical articles, it could be much better.
• The problem consist of:
• 1) Finding a prosthetist, that actually knows what he is talking about. Not so easy, as they all claim to
be experts….
• 2) COST. For most non amputees, it is always a surprise. A socket cost around $12,000! (Yes, you are
reading right!) and, the icing on the cake is… MOST insurances do not pay at all, or pay only a minor
fraction of the cost. Prosthetics are included in insurance contracts under durable medical
equipment*. YES, it is covered but maximum payment is limited to……. $2,000/year. Nobody check
these things unless… they lose a limb.
*BTW: I wish they were durable. I have yet to find a knee that last more than 2 years!!
Note: I did the strapping system and ratchet buckles. The dimensions
of the straps are critical in maintaining the proper shape of the socket.
Earlier system used fabric straps that used to stretch over time. Deep recesses over the iliac crest
provides positive support, limiting
“pumping” and increasing toe
PROSTHETICS - SOCKET clearance (my idea)
$30,000
Knee Axis
Knee Joint
2 However, the knee is already
fully extended and cannot
extend further.
Knee Axis
Knee Joint
2 The knee will buckle under
load.
Knee rotator
(Critical for driving)
Sliding adapter (Ti)
Single axis knees are not recommended for HD prosthesis. True but,
A WELL ALIGNED single axis knee works very well in an HD prosthesis
Knee rotator
(Critical for driving)
Sliding adapter (Ti)
HD Prosthesis using the TEH-LIN TGK-5PSO Polycentric 5-Bar
Pneumatic knee with adjustable centroid
Pylon (al)
OSSUR Reflex VSP
Offset adapter (Ti) Foot
THE-LIN 5-BAR KNEE CARBON Pylon
with Ti adapter
Knee rotator
(Critical for driving)
HD – TOE CLEARANCE
L
FOOT
l
T
GROUND FLOOR
KNEE JOINT
HD – TOE CLEARANCE
Toe Clearance T
Toe clearance is always an issue for all above knee T = R-L
(AK) amputees and a very big issue for HD 𝑻= 𝒍𝟐 + 𝑳𝟐 − 𝑳
amputees.
If the toes hit the floor during the swing phase, the
knee may not lock at heel strike and buckle under
load, resulting in a fall.
AK amputees have good control of their prosthetic
knee and the interface socket/stump provides
enhanced proprioception. HD amputees do not!
To minimize such event, it is customary to shorten FOOT
the prosthetic leg. However, this results in a non
symmetrical gait and pronounced limp.
T
GROUND FLOOR
HD – TOE CLEARANCE
30
One way to minimize the toe clearance is to
C (mm)
increase L. Clearance C as a function of L C
28
The graph shows that by increasing L by
200mm, we gain 8mm of toe clearance. That
may not sound a lot but I can clearly feel a 26
change of 1 or 2mm in length.
L=500-700mm
we want the prosthetic knee to be at the
same level as the “good” knee and for the
22
same reasons we want the prosthetic foot to
be the same size as the good foot.
20
In the 4-bar linkage A-B, C-D, the rotation center of the segment Centroid
B-D relative to A-C is located at the intersection the lines passing
through A-B and B-D. This virtual center of rotation is called
the centroid (or centrode by the O&P community)
The centroid is not fixed but is a function of the angle of
the knee. Note that the centroid moves in the vertical
direction AND in the posterior/anterior direction. This has
L > 500mm
important consequences in term of alignment and
stability.
HD – TOE CLEARANCE
Toe Clearance T
Or, we move the foot! T = R-L
𝑻= 𝒍𝟐 + 𝑳𝟐 − 𝑳
We need to build a foot/shin/knee
assembly in such a way that the toes
will rise in the final phase of the
swing.
Between α = 0 and α = α 1 , β < 90°
For α > α 1 β = 90° α
β = 90° under load α1 FOOT
β=90°
T
GROUND FLOOR
KNEE JOINT
HD – TOE CLEARANCE
Toe Clearance T
Or, we move the foot! T = R-L
𝑻= 𝒍𝟐 + 𝑳𝟐 − 𝑳
We need to build a foot/shin/knee
assembly in such a way that the toes
will rise in the final phase of the
swing.
Between α = 0 and α = α 1 , β < 90°
For α > α 1 β = 90° α
β = 90° under load α1 FOOT
β=90°
T
GROUND FLOOR
1P50R Hydracadence II
HD – TOE CLEARANCE
Such a knee/foot system exists. PROTEOR, a French
manufacturer developed such system: The 1P50R
Hydracadence II.
Three possibilities
1) LEGO
YES! I hear you laughing but you would be surprised to see what can be done with the LEGO technics pieces. I even
built a functioning clock escapement to impress the kids. (Photos lost unfortunately)
2) COMPUTER MODELING
There are many software solutions. However, most are designed for the professional community and very
expensive. In addition, the learning curve with such programs is extremely steep. GOOGLE created SKETCHUP, a
FREE 3D modeling package. It is powerful yet, relatively easy to learn. SKETCHYPHYSICS is a free plugin for
SKETCHUP based on the NEWTON SDK physics engine from NEWTON GAME DYNAMICS. SKETCHYPHYSICS is VERY
buggy but… it is FREE.
3) DO THE MATHS
Solve analytically the motion of each part of the system (Major Trigonometric Cluster F*@!&). Then, simulate in EXCEL.
HD – TOE CLEARANCE – KINEMATICS MODELING
First test of kinematics modeling with Google Sketchup and Sketchyphysics. Sketchup was primarily designed for
architects but can be used for other applications. 3D modelling is never easy but Google developed a user friendly
interface. Sketchyphysics on the other hand is obscure and buggy but is the only free application I could find.
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
Four-Bar Linkage Animation using Google Sketchup and Sketchyphysics Plug-In
HD – TOE CLEARANCE – KINEMATICS MODELING
Model or a 5-bar linkage KERKYTHEA is extremely
modelled in Sketchup8 and powerful. It is free and…
Rendered in KERKYTHEA TOTALLY user UNFRIENDLY…
Model or a 5-bar linkage KERKYTHEA is extremely
modelled in Sketchup8 and powerful. It is free and…
Rendered in KERKYTHEA TOTALLY user UNFRIENDLY…
Model or a 5-bar linkage KERKYTHEA is extremely
modelled in Sketchup8 and powerful. It is free and…
Rendered in KERKYTHEA TOTALLY user UNFRIENDLY…
Model or a 5-bar linkage KERKYTHEA is extremely
modelled in Sketchup8 and powerful. It is free and…
Rendered in KERKYTHEA TOTALLY user UNFRIENDLY…
HD – KINEMATICS
TEH-LIN, a Taiwanese manufacturer, recently introduced
two 5-bar knees. These knees do not use a proper 5-bar
linkage but offer the possibility of altering the 4-bar
geometry and the centroid trajectory through the motion
of the knee.
PROJECT IN PROGRESS
The test jig and test foot have been built but no
measurement and processing have been done yet.
HD - ADDENDUM
HD – ADDENDUM (2)
HD ADDENDUM(3)
HD ADDENDUM(4)
TEH-LIN KK950 “FIVE”-BAR POLYCENTRIC KNEE
x y D
4-Bar linkage
A 0 0 104.5 NOTE: The
Geometry
distance DC
B 103.3 15.9 60.1 is adjustable
The picture of the 4-bar polycentric prosthetic knee is The coordinates of the joints of the 4-bar linkage are
calibrated in dimensions using Photoshop. The axis measured relative to A, defined as the knee axis of
centered on the shank pylon is plotted, as well as the rotation. The angle of rotation of the knee is defined as
projection of the top pyramid adapter. (Scale 1:1) the angle of the pylon from vertical . (Scale 1:1)
540mm
200mm
KINEMATIC ANALYSIS
Microsoft Excel
140
40
Shank Pylon
-60
-100 0 100 200 300 400 500 600
200mm
KINEMATIC ANALYSIS
Microsoft Excel
140
40
Shank Pylon
-60
-100 0 100 200 300 400 500 600
And YES! I did suffer and banged my head on the wall on a few occasions. However, I took the opportunity to
dramatically enrich my vocabulary in trigonometric obscenities… And do not let me into the cluster f#@*#! of video
codecs compatibles with just about nothing else….
Note: The motion of each leg component is calculated from classic trigonometry. The centroid is calculated as the
center of a circle passing through three adjacent points of the trajectory.
KINEMATIC ANALYSIS 40
• The prices on EBAY are low today because the demand is low. WHY?
• Prosthetist do not and cannot use used components.
Apparently for insurance reason. Sounds like a good excuse to me, as they
make significant profit on the components.
• The prosthetic market is quite unique as the customer (the amputee)
doesn’t decide what components to use.
HD - COMPONENTS
• The customer has a good medical insurance. The prosthetist will order the
most expensive (not necessarily the most appropriate) components the insurance
accept to pay. If the leg doesn’t work, it will eventually end up on EBAY.
• The customer does not have medical insurance. The prosthetist will order
the cheapest components. Nevertheless, the leg will still cost $20,000 (AK).
The leg doesn’t work and the amputee will sell the components on EBAY.
• The customer does not have medical insurance and doesn’t have $20,000.
NO PROBLEMS! He can buy a pair of crutches at Walgreen for $20! Or,
beg at the traffic light. In less than 15 years, he will have enough money for
a leg… Unless he jumped under the 18-wheeler, of course….
HD - COMPONENTS
PROSTHETICS
Partial collection of
prosthetic knees
Partial collection
of prosthetic feet
Pylons with integral
Pyramid Adapter
Partial collection of
30mm prosthetic
pylons (aluminum
and carbon fiber) Carbon Fiber
Carbon Fiber
Carbon Fiber
Partial collection of various Adjustable Offset
pyramid adapter/tube Adapter (Titanium)
clamps. Mainly polished
Titanium, some Stainless
Steel and Aluminum. Adjustable Height
Adapter (Titanium)
Male Adapter
(Aluminum)
(Titanium)
Angled Adapter
for HD Prosthesis
(Titanium)