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State of the Art Review of Knee–Ankle–Foot Orthoses

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Abstract

Knee–ankle–foot orthoses (KAFOs) are used to assist in ambulation. The purpose of this paper is to review existing KAFO designs which can be grouped into passive KAFOs, stance control (SC) KAFOs, and dynamic KAFOs. The conventional passive KAFOs do not provide any active control for knee motions. SCKAFOs lock the knee joint during the stance phase and allow free rotations during the swing phase. Some SCKAFOs switch between the stance and swing phases using body posture, while others use some kind of a control system to perform this switch. Finally, dynamic KAFOs control the knee joint during both stance and swing phases. Four dynamic systems are identified in the literature that use pneumatics, linear springs, hydraulics, and torsional rods made of superelastic alloys to control the knee joint during the gait cycle. However, only the two systems that use linear springs and torsional rods can reproduce the normal knee stiffness pattern which has two distinct characteristics: a soft stiffness during the swing phase and a hard stiffness during the stance phase. This review indicates that there is a need to conduct research regarding new KAFO designs that duplicate normal knee function during the whole gait cycle.

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References

  1. Andani, M. T., A. Alipour, and M. Elahinia. Coupled rate-dependent superelastic behavior of shape memory alloy bars induced by combined axial-torsional loading: a semi-analytic modeling. J. Intell. Mater. Syst. Struct. 24:1995–2007, 2013.

  2. Arazpour, M., A. Chitsazan, M. A. Bani, G. Rouhi, F. T. Ghomshe, and S. W. Hutchins. The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis. Prosthet Orthot Int. 37:411–414, 2013.

    Article  PubMed  Google Scholar 

  3. Hennessey, W. J. Lower limb orthotic devices. In: Physical Medicine and Rehabilitation, edited by R. L. Braddom, L. Chan, M. A. Harrast, K. J. Kowalske, D. J. Matthews, K. T. Ragnarsson, and K. A. Stolp. Philadelphia: Elsevier W. B. Saunders Company, 2011, pp. 333–357.

  4. Clark, D. R., J. Perry, and T. R. Lunsford. Case studies—orthotic management of the adult post polio patient. JPO 40:43–50, 1986.

    Google Scholar 

  5. Condie, D., and J. Lamb. Knee–ankle–foot orthoses. In: Biomechanical Basis of Orthotic Management, edited by P. Bowker, D. N. Condie, D. L. Bader, D. J. Bratt, and W. A. Wallace. Oxford: Butterworth-Heinemann, 1993, pp. 146–167.

    Google Scholar 

  6. Cullell, A., J. C. Moreno, E. Rocon, A. F. Cordero, and J. L. Pons. Biologically based design of an actuator system for a knee–ankle–foot orthosis. Mech Mach Theor. 44:860–872, 2009.

    Article  Google Scholar 

  7. Davids, J. R. Normal gait and assessment of gait disorders. In: Lovell & Winter’s Pediatric Orthopaedics, edited by R. T. Morrissy, and S. L. Weinstein. Philadelphia: Lippincott Williams & Wilkins, 2000, pp. 131–156.

    Google Scholar 

  8. Fatone, S. A review of the literature pertaining to KAFOs and HKAFOs for ambulation. JPO 18:137–163, 2006.

    Google Scholar 

  9. http://professionals.ottobockus.com/cps/rde/xbcr/ob_us_en/12032294.1_KAFO_FamilyBro_v3.pdf.

  10. http://professionals.ottobockus.com/cps/rde/xbcr/ob_us_en/646D642-EN-02-1207w.pdf.

  11. http://www.capstoneorthopedic.com/services/kafo/stance.php.

  12. Hwang, S., S. Kang, K. Chao, and Y. Kim. Biomechanical effect of electromechanical knee-ankle-foot-orthosis on knee joint control in patients with poliomyelitis. Med. Biol. Eng. Comput. 46:541–549, 2008.

    Article  PubMed  Google Scholar 

  13. Irby, S. E., K. A. Bernhardt, D. A. Morrow, and K. R. Kaufman. Fatigue test device for stance phase control knee orthoses. JPO 15:143–147, 2003.

    Google Scholar 

  14. Irby, S. E., K. R. Kaufman, R. W. Wirta, and D. H. Sutherland. Optimization and application of a wrap-spring clutch to a dynamic KAFO. IEEE Trans Rehabil Eng. 7:130–134, 1999.

    Article  CAS  PubMed  Google Scholar 

  15. Lagoudas, D. C. Shape Memory Alloys: Modeling and Engineering Applications. New York: Springer Science and Business Media, LLC., pp. 11–15, 2008.

    Google Scholar 

  16. McMillan, A. G., K. Kendrick, J. W. Michael, J. Aronson, and G. W. Horton. Preliminary Evidence for Effectiveness of a Stance Control Orthosis. JPO. 16:6–13, 2004.

    Google Scholar 

  17. Michael, J. W. Summary from the academy’s seventh state of the science conference on knee-ankle-foot orthoses for ambulation. JPO. 18:132, 2006.

    Google Scholar 

  18. Raftopoulos, D. D., L. Poulos, and C. W. Armstrong. Knee-ankle-foot orthotic with a hydraulic twist. SOMA/JANUARY, 1988, pp. 49–53.

  19. Redford, J. B., J. V. Basmajian, and P. Trautman. Orthotics: Clinical Practice and Rehabilitation Technology. New York: Churchill Livingstone, 1995.

    Google Scholar 

  20. Sawicki, G. S., and D. P. Ferris. A pneumatically powered knee–ankle–foot orthosis with myoelectric activation and inhibition. J Neuroeng Rehabil. 6:23–38, 2009.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Shamaei, K., P. C. Napolitano, and A. M. Dollar. Design and functional evaluation of a quasi-passive compliant stance control knee–ankle–foot orthosis. IEEE Trans Rehabil Eng. 22:258–268, 2014.

    Article  Google Scholar 

  22. Tian, F., M. Elahinia, and M. S. Hefzy. A dynamic knee-ankle-foot orthosis with superelastic actuators. Proceedings of the ASME 2013 Conference on Smart Material, Adaptive Structures and Intelligent Systems, Paper #SMASIS2013-3044. September 16–18, 2013, Snowbird, Utah, USA.

  23. Tian, F., M. Elahinia, and M. S. Hefzy. Design and evaluation of a knee actuator for a dynamic knee-ankle-foot orthosis. In: Proceedings of the ASME 2014 Conference on Smart Material, Adaptive Structures and Intelligent Systems, Paper #SMASIS2014-7605 (CD publication). September 8–10, 2014, Newport, Rhode Island, USA.

  24. Tian, F., M. S. Hefzy, and M. Elahinia. Development of a dynamic knee actuator for a KAFO using superelastic alloys. In: ASME 2014 International Mechanical Engineering Congress and Exposition, Paper #IMECE2014-40431, November 14–20, 2014, Montreal, Canada.

  25. Winter, D. A. Biomechanics and Motor Control of Human Movement. Hoboken: John Wiley & Sons Inc, pp. 321–335, 2009.

    Book  Google Scholar 

  26. Yakimovich, T., J. Kofman, and E. D. Lemaire. Design and evaluation of a stance-control knee–ankle–foot orthosis knee joint. IEEE Trans Neural Syst Rehabil Eng. 14:361–369, 2006.

    Article  PubMed  Google Scholar 

  27. Yakimovich, T., E. D. Lemaire, and J. Kofman. Engineering design review of stance-control knee–ankle–foot orthoses. J Rehabil Res Dev 46:257–268, 2009.

    Article  PubMed  Google Scholar 

  28. Yates, G. A method for the provision of lightweight aesthetic orthopaedic appliances. Orthopedics. Oxford 1:153–162, 1968.

    Google Scholar 

  29. Zissimopoulos, A., S. Fatone, and S. A. Gard. Biomechanical and energetic effects of a stance-control orthotic knee joint. J Rehabil Res Dev. 44:503–514, 2007.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was partially supported by Grant BCS-0931643 from the General & Age Related Disabilities Engineering (GARDE) program from the Biomedical Engineering and Engineering Healthcare cluster of the Chemical, Bioengineering, Environmental, and Transport Systems (CBET) division of the National Science Foundation.

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Authors and Affiliations

  1. Biomechanics and Assistive Technology Laboratory, Departments of Bioengineering and Mechanical, Industrial and Manufacturing Engineering, The College of Engineering, The University of Toledo, 1610 N. Westwood, Toledo, OH, 43607, USA

    Feng Tian & Mohamed Samir Hefzy

  2. Dynamic and Smart Systems Laboratory, Departments of Bioengineering and Mechanical, Industrial and Manufacturing Engineering, The College of Engineering, The University of Toledo, 1610 N. Westwood, Toledo, OH, 43607, USA

    Feng Tian & Mohammad Elahinia

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  1. Feng Tian
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  2. Mohamed Samir Hefzy
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  3. Mohammad Elahinia
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Correspondence to Mohamed Samir Hefzy.

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Associate Editor Amit Gefen oversaw the review of this article.

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Tian, F., Hefzy, M.S. & Elahinia, M. State of the Art Review of Knee–Ankle–Foot Orthoses. Ann Biomed Eng 43, 427–441 (2015). https://doi.org/10.1007/s10439-014-1217-z

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  • DOI: https://doi.org/10.1007/s10439-014-1217-z

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