Brad Smyth's Story
The upgrades are awesome. For the first time in ten years, I am able to walk step over step, both up and down stairs. With the RHEO KNEE XC, there is so much more feel and strength through the knee as you push through it. So far, I have not felt as though the knee is going to give way as I step through it on any surface. I have tried a number of different terrains from wet slippery rocks to grass, dirt, gravel and bush tracks.
The Pro-Flex is almost like having an ankle again. When you step through on flat ground or inclines, it doesn’t take any extra effort to keep moving forward. I have noticed on slight declines that I am able to walk with my normal stride, and I don’t need to half step to keep control.
I have started doing things again that were a lot harder to do with my old set up. I have ridden a two wheel bike for the first time in ten years. I have been able to complete some of the more difficult bush tracks and climbs.
I recently went on a hike to a water fall and was able to climb around at the base and was not worried that I may get wet or that my knee would give way. I had better stability to climb over the wet slippery rocks and was even able to challenge the climbing ability of my children through rocks and crevices that I never would have been able to before.
I was lucky enough to be able to be part of the AOPA event in Melbourne. While at this event, I was able to spend time with Cathy Howells who put me through my paces and taught few new tricks that the RHOE KNEE XC allows you to do. I am now able to do squats, lunges and by locking the knee, a more even push up. As the guys from Össur were there, I also had the opportunity to try the Pro-Flex XC. While I had this foot on, Cathy again gave me some new challenges, and I was able to run. It felt good and somewhat free to be a little…dare I say it… 'normal'.
Another great thing is that you can connect your phone to the knee and keep track of the steps and battery levels. In the 11 weeks I have had the RHEO KNEE XC, I have clocked 186,758 steps.
I am looking forward to the Össur Mobility Clinic in Melbourne this April 2017 and hopefully learning some additional new skills. I am very thankful for the opportunity and for the improvements to my lifestyle.
Mitch Farrar on Brad’s RHEO KNEE XC Experience
When I first came across the RHEO KNEE XC, Brad instantly came to mind. The additional features it offers (e.g. running, cycling, up-stairs modes) on top of those already offered in the RHEO KNEE seemed like a great option for unlocking some of the potential of such an active prosthetic user. The articulation of the Pro-Flex foot module without the use of any hydraulics or microprocessor technology also took my interest, as restriction in ankle range of motion is a common factor which limits a large proportion of all lower limb amputees. As such I was keen to trial the new knee and foot, as was Brad.
Upon first trialling the knee and foot it didn’t take long for Brad to figure out how to use it properly, particularly with him having worn the second generation RHEO KNEE for the last five years. Walking on level ground felt and appeared much similar to Brad’s second generation RHEO KNEE. The only difference he felt was due to the alternate foot module being used. He reported the impact upon weight acceptance of the sound limb to be lessened. This is consistent with observations made during objective gait analysis of an increase in the amount of dorsiflexion in the prosthetic ankle and a lesser elevation in the body centre of mass during the mid- to terminal-stance phases of the prosthetic limb.
While there was more compliance in the ankle, Brad didn’t report any loss of energy return, but rather that it was quickly given in the pre-swing phase of stance, rather than progressively building up through terminal stance and into pre-swing. Furthermore, he did not feel any difference or loss in shock attenuation despite now not using the Re-Flex Rotate. However, this was only reported after use whilst walking at a self-selected walking speed on level ground. The shock absorption capacity of the foot may ring true when he partakes in activities of a higher impact level.
The greater range of ankle motion became even more apparent when ascending and descending inclines of 15°. Brad was able to achieve foot flat more quickly and maintain a foot flat position for much longer through the stance phase without any unnatural gait deviations. This is of particular importance to me as a clinician as it greatly improves the safety of the prosthesis by maximising traction with the walking surface. Brad’s feedback was also positive, suggesting that ascending inclines was particularly simpler compared to when using the Reflex Rotate.
In descending stairs, Brad reported feeling much safer as the resistance in the knee unit felt more supportive. I, however, noted that the articulation of the Pro-Flex working in tandem with the RHEO KNEE XC was beneficial in allowing him to progressively move his body weight anteriorly and descend to the next step more smoothly than his previous prosthesis.
Ascending stairs was also a positive experience. Within 30 minutes of training and practice, Brad was able to initiate the stair ascent function and climb a flight of 19 stairs. Initially this was quite difficult and requires assistance of a handrail, but with further practice became easier. However, wearing the Pro-Flex foot made initiating the stair ascent function more difficult than when wearing the Pro-Flex XC.
Since this trial, Brad has been definitively fitted with the RHEO KNEE XC and Pro-Flex. Aligning and programming this prosthesis was very quick and straight forward and user friendly, using the PC version. He continues to use the prosthesis for his activities of daily living and hopes to use it when going hiking with his family. He has also begun to use the cycling mode and appears to be managing it quite well.
Overall fitting the RHEO KNEE XC and Pro-Flex foot to Brad was a very positive experience. It has allowed him to tap into some potential that he, as a strong, agile and very active transfemoral amputee, most definitely has had for some time now, such as the possibility to ascend stairs.
I feel the Pro-Flex foot, however, has a broader application in terms of not only also being suitable for transtibial amputees, but also for those of a lower activity level, particularly with regard to ascending and descending inclines. I have since fit two Pro-Flex feet to transtibial amputees of a lower activity level and both are very happy with its function.