Prosthetic Forum
SUMMARY REPORT
In a program sponsored by the American Academy of Orthotists and Prosthetists, and funded in part by Otto Bock Health Care, Walter Reed Army Medical Center hosted a forum May 21-22, 2003, to begin establishing clinical protocols and procedures for microprocessor prosthetic knees in the treatment of individuals with a transfemoral amputation.
Forum participants, selected for personal clinical experience in fitting, prescribing, evaluating and/or researching the microprocessor knee component, included: Dale Berry, CP, CP(c), Joseph Miller, MEd, CP, Frank Snell, CPO, FAAOP, Manuel R. Garcia, CP, Phillip Conley, CP, Nicholas Guarino, CP, James Breakey, PhD, CP, Alfred Lehneis, CPO, Kenton R. Kaufman, PhD, PE, John W. "Rick" Richards, Jr., MD, MMM, CPE, DABFP, DABMM, DABQAURP, FAAFP, FAPCE, Mary Ann Miknevich, MD, Ron Seymour, PT, PhD, and Todd Anderson, CP, FAAOP.
For the purpose of this symposium, a microprocessor controlled knee was defined by the group as an external prosthetic knee component that contained a Central Processing Unit (CPU) capable of external programming and modifications. The program is utilized to adjust the functional performance of the knee based upon environmental changes in gait and movement of the patient.
Topics included patient selection, evaluation, and follow-up; component variations; physical therapy; documentation; and outcomes measurement and analysis. During her presentation, Dr. Miknevich identified specific patient considerations related to microprocessor knee application; she discussed pre-prosthetic care issues and the role of the rehabilitation team in assessment and goal development related to microprocessor fitting. This presentation also identified specific indications and contraindications related to surgery and microprocessor knee application, and proposed specific physical and functional fitting criteria for new amputees to be considered for this technology.
Supporting and enabling individuals to accomplish activities of daily living while using a microprocessor knee component were common themes. Several presenters stressed the importance of accurate patient evaluation, appropriate physical therapy, and followup. The importance and utilization of adequate selection criteria to identify which individuals with a transfemoral amputation should be considered for a microprocessor knee component were discussed. Please see the Microprocessor Knee Patient Evaluation Protocol on page 33. Dr. Breakey suggested that consideration should be given to the needs of the patient as well as the capabilities of the selected knee. Dr. Seymour concurred, indicating that regardless of the prosthetic technology being introduced to an individual with a transfemoral amputation, it is essential that the therapy protocol be appropriate and relevant to the individual's capabilities.
Also highlighted were enhanced communication and education, uniform documentation and the need for further research. Several case presentations were reviewed that demonstrated amputee acceptance and the successful clinical application and use of this technology. Presenters compared microprocessor-controlled knee technology with existing prosthetic designs; perceived benefits included function, stability, comfort and security.
The group acknowledged that there is a lack of objective data to support the use of this technology and recommended that quantitative studies be established to measure clinical outcomes. Dr. Kaufman indicated that maximizing outcome is a prerequisite for documenting a worthwhile treatment plan and felt that objective gait analysis is a valuable tool that could be used to assess these demands.
SUGGESTED READING
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Microprocessor Knee Patient Evaluation Protocol - Page 1
The following form is presented by the group and can be used to capture essential information and relative data, thus providing a consistent and uniform standard for determining the appropriate application of microprocessor controlled technology.
Page 2, Practitioner and Patient Information
The top portion of the page is completed by the practitioner with general professional contact information.
The lower 2/3 of the page is completed by the patient to provide personal, medical history and activities of daily living information.
Page 3, Prosthetics Activity & Comfort Assessment
This page is completed by the patient to assess the function, comfort and stability of the present prosthesis.
If the patient is a new amputee and does not presently have a prosthesis, the page should be marked NA for Not Applicable.
Page 4, Functional and Gait Evaluation
To be completed by the practitioner to identify the patient's functional level and gait deviations.
If the patient is a new amputee and does not presently have a prosthesis, the gait deviation portion should be marked NA for Not Applicable.
Page 5, Prosthetic Component and Residual Limb Evaluation
To be completed by the practitioner to assess the condition and status of select prosthetic components on the existing prosthesis, specifically, why does the present component require replacement.
If the patient is a new amputee and does not presently have a prosthesis, the prosthetic component evaluation portion should be marked NA for Not Applicable.
Page 6, Prosthetic Recommendations
To be completed by the practitioner to identify the specific components required for the patient with specific rationale as to how and why the recommended components will benefit the patient.
Page 7, Activities of Daily Living (ADL) Justification
To be completed by the practitioner to identify how the recommended components will benefit and/or assist the patient in completing specific activities of daily living.
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