(OANDP-L) Trans-femoral stumble recovery

(OANDP-L) Trans-femoral stumble recovery

Wieland Kaphingst

Question: What is the most appropriate prosthetic knee reaction for stumble
recovery of a trans-femoral patient?

Situation: Patient stumbles because of an obstacle or because of lack of
ground clearance every once in a while (prosthetic length is correct). They
may be able to catch themselves or they may actually fall after stumbling.

In this instance:
A. Is it better to use a knee that would yield with flexion resistance (as a
Mauch might do)?
B. better to have a knee that would easily collapse (as no stance control at
all)?
C. better to have a knee that resists further flexion but allows for active
extension under load bearing at the same time ( as the ipos safety knee or
the TKO)?

I know that the Total Knee is safe until forefoot contact. But I do not
consider this as a stumble recovery mechanism.

I know that stumbling and potentially falling are very complex situations,
which may provide different situations at any time and that the personal
reaction to catch stumbling may be varying regarding various K-levels. But
solutions in prosthetic knees today are either one or the other. Obviously
their behavior is not individually tailorable to the various situations of
stumbling. Is there any published research data on stumble recovery (or
stumbling and falling) in trans-femoral amputees available at all?
Hints for related literature would be appreciated.

What is the best average approach - what your personal experience or
preference?

If you would please answer with either A., B. or C. as your preferred option
- and if you find the time - comments would also be appreciated.

Thank you for your advice.

Wieland Kaphingst, CP and CPO-EC