Enhancing Above-Knee Prosthetic Design for Inclusive Workplaces: Ergonomic Considerations in Manual Material Handling
Main Article Content
Keywords
disability, ergonomics, material handling, prosthetic, stability
Abstract
Employment is crucial for economic sustainability and social inclusion, yet individuals with disabilities face significant barriers. Globally, only 44% of disabled individuals are employed compared to 75% of those without disabilities. Manual material handling (MMH) relies heavily on stability and control in demanding industries such as manufacturing and logistics. Such demands create challenges for individuals with above-knee prostheses, as most current designs focus on walking and do not adequately support the postural and load-bearing requirements of MMH tasks. This study aims to evaluate the performance of transfemoral prosthesis designs during MMH, analyzing the effects of container type, load mass, and their interaction on gait efficiency, discomfort, and stability. Eight male unilateral above-knee amputees (24–39 y) carried handled and handle-less boxes loaded from 4 to 10 kg in a randomised within-subject trial. Gait deviation, perceived discomfort, and steadiness were captured with self-report measures. Two-way analysis of variance analyses showed a significant container × load interaction: handle-less 10 kg loads produced the greatest lateral trunk lean toward the prosthetic side, whereas lighter handled loads minimised deviation. Increasing load also elevated discomfort in the back, waist, stump and contralateral arm and reduced perceived stability. Observed lateral lean and impact-related knee extension suggest three priority modifications: (1) add socket adduction within an ischial-containment design to improve femoral stabilisation, (2) increase knee-swing friction to soften terminal impact, and (3) fit dual-keel feet to cushion heel strike. Implementing these changes may reduce gait errors and fatigue, raising safe lifting capacity for transfemoral prosthesis users in MMH task. Nonetheless, the male-only sample may not capture gender-specific
gait strategies; future trials should include female participants and a larger cohort to verify generalisability. These preliminary findings still offer insights into improving prosthetic designs to enhance safety, functionality, and inclusion in industrial MMH tasks.
References
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[38]A. Hewson, S. Dent, and A. Sawers, “Strength deficits in lower limb prosthesis users: A scoping review,” Prosthetics & Orthotics International, vol. 44, no. 5, pp. 323–340, Oct. 2020, doi: 10.1177/0309364620930176.
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[2]J. M. Orlando, B. Li, B. Bodt, and M. A. Lobo, “Users’ perceptions about lower extremity orthotic devices: A systematic review,” Archives of Physical Medicine and Rehabilitation, vol. 104, no. 4, pp. 645–655, Apr. 2023, doi: 10.1016/j.apmr.2022.10.010.
[3]I. De-Rosende Celeiro, L. Simón Sanjuán, and S. Santos-del-Riego, “Activities of daily living in people with lower limb amputation: Outcomes of an intervention to reduce dependence in pre-prosthetic phase,” Disability and Rehabilitation, vol. 39, no. 18, pp. 1799–1806, Aug. 2017, doi: 10.1080/09638288.2016.1211757.
[4]K. Alluhydan, M. I. H. Siddiqui, and H. Elkanani, “Functionality and comfort design of lower-limb prosthetics: A review,” Journal of Disability Research, vol. 2, no. 3, Sep. 2023, doi: 10.57197/JDR-2023-0031
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[6]M. Du, M. Zhao, and Y. Fu, “Revisiting urban sustainability from access to jobs: Assessment of economic gain versus loss of social equity,” Environmental Impact Assessment Review, vol. 85, p. 106456, Nov. 2020, doi: 10.1016/j.eiar.2020.106456.
[7]M. C. Saleh and S. M. Bruyère, “Leveraging employer practices in global regulatory frameworks to improve employment outcomes for people with disabilities,” SI, vol. 6, no. 1, pp. 18–28, Mar. 2018, doi: 10.17645/si.v6i1.1201.
[8]N. Qiu, Y. Jiang, Z. Sun, and M. Du, “The impact of disability-related deprivation on employment opportunity at the neighborhood level: does family socioeconomic status matter?,” Front. Public Health, vol. 11, p. 1232829, Aug. 2023, doi: 10.3389/fpubh.2023.1232829.
[9]E. O. Oloruntola et al., “Experiences and needs of persons who have undergone limb amputation in Saki West, Oyo State, Nigeria,” International Health, p. ihae068, Nov. 2024, doi: 10.1093/inthealth/ihae068.
[10]R. Stuckey, P. Draganovic, M. M. Ullah, E. Fossey, and M. P. Dillon, “Barriers and facilitators to work participation for persons with lower limb amputations in Bangladesh following prosthetic rehabilitation,” Prosthetics & Orthotics International, vol. 44, no. 5, pp. 279–289, Oct. 2020, doi: 10.1177/0309364620934322.
[11]R. K. Hastuti, R. P. Dewi, Pramana, and H. Sadaly, “Kendala mewujudkan pembangunan inklusif penyandang disabilitas,” The SMERU Research Institute, 2020.
[12]S. Ananian, G. Dellaferrera, and International Labour Organization Research Department, A study on the employment and wage outcomes of people with disabilities. Geneva: ILO, 2024. doi: 10.54394/YRCN8597.
[13]O. Quirico and C. Radavoi, “Economics and disability rights: Inclusive sustainability,” in Inclusive Sustainability, O. Quirico, Ed., Singapore: Springer Nature Singapore, 2022, pp. 107–129. doi: 10.1007/978-981-19-0782-1_5.
[14]M. Rajendran, A. Sajeev, R. Shanmugavel, and T. Rajpradeesh, “Ergonomic evaluation of workers during manual material handling,” Materials Today: Proceedings, vol. 46, pp. 7770–7776, 2021, doi: 10.1016/j.matpr.2021.02.283.
[15]T. M. Köhler, S. Blumentritt, F. Braatz, and M. Bellmann, “The impact of transfemoral socket adduction on pelvic and trunk stabilization during level walking – A biomechanical study,” Gait & Posture, vol. 89, pp. 169–177, Sep. 2021, doi: 10.1016/j.gaitpost.2021.06.024.
[16]S. Kumar and S. Bhowmik, “Principles and biomechanical response of normal gait cycle to measure gait parameters for the alignment of prosthetics limb: A technical report,” Prosthetics & Orthotics International, Dec. 2024, doi: 10.1097/PXR.0000000000000391.
[17]E. Pienaar, “Prosthetic Use by Persons with Unilateral Above Knee Amputation in the Western Cape,” M.S. thesis, Stellenbosch University, Stellenbosch, South Africa, 2018.
[18]J. T. Kahle, M. J. Highsmith, H. Schaepper, A. Johannesson, M. S. Orendurff, and K. Kaufman, “Predicting walking ability following lower limb amputation: An updated systematic literature review,” technol innov, vol. 18, no. 2, pp. 125–137, Sep. 2016, doi: 10.21300/18.2-3.2016.125.
[19]O. Mohamed and H. Appling, “Clinical assessment of gait,” in Orthotics and Prosthetics in Rehabilitation, Elsevier, 2020, pp. 102–143. doi: 10.1016/B978-0-323-60913-5.00005-2.
[20]P. F. Paulus, “The influence of socket design on gait, balance, and loading in individuals with transfemoral amputations,” Ph.D. dissertation, University of Pittsburgh, Pittsburgh, PA, 2020.
[21]W. Anderst, G. Fiedler, K. Onishi, G. McKernan, T. Gale, and P. Paulus, “Within-subject effects of standardized prosthetic socket modifications on physical function and patient-reported outcomes,” Trials, vol. 23, no. 1, p. 299, Dec. 2022, doi: 10.1186/s13063-022-06205-z.
[22]C. G. Drury, “Handles for manual materials handling,” Applied Ergonomics, vol. 11, no. 1, pp. 35–42, Mar. 1980, doi: 10.1016/0003-6870(80)90120-9.
[23]M. A. Ayoub, “Optimum design of containers for manual material handling tasks,” Applied Ergonomics, vol. 8, no. 2, pp. 67–72, Jun. 1977, doi: 10.1016/0003-6870(77)90055-2.
[24]N. A. Sprunger, J. Z. Laferrier, D. M. Collins, and R. A. Cooper, “Utilization of prostheses and mobility-related assistive technology among service members and veterans from vietnam and operation iraqi freedom/operation enduring freedom,” JPO Journal of Prosthetics and Orthotics, vol. 24, no. 3, pp. 144–152, Jul. 2012, doi: 10.1097/JPO.0b013e31825b3a4b.
[25]J. C. Shin, E. J. Kim, C. I. Park, E. S. Park, and K.-H. Shin, “Clinical features and outcomes following bilateral lower limb amputation in Korea,” Prosthetics & Orthotics International, vol. 30, no. 2, pp. 155–164, Aug. 2006, doi: 10.1080/03093640600608074.
[26]J. E. Edelstein and K. K. Chui, “Transfemoral prostheses,” in Orthotics and Prosthetics in Rehabilitation, Elsevier, 2020, pp. 635–653. doi: 10.1016/B978-0-323-60913-5.00024-6.
[27]A. Domínguez-Ruiz et al., “Low limb prostheses and complex human prosthetic interaction: A systematic literature review,” Front. Robot. AI, vol. 10, p. 1032748, Feb. 2023, doi: 10.3389/frobt.2023.1032748.
[28]F. Gariboldi, “Development and evaluation of technologies for the design and production of prosthetic components for paralympic athletes,” Università degli Studi di Padova, Padua, Italy, 2025. Accessed: Apr. 24, 2025. [Online]. Available: https://www.research.unipd.it/handle/11577/3548327
[29]K. A. Samuelsson, O. Töytäri, A.-L. Salminen, and Å. Brandt, “Effects of lower limb prosthesis on activity, participation, and quality of life: a systematic review,” Prosthetics and Orthotics International, vol. 36, no. 2, pp. 145–158, 2012.
[30]K. M. Cyr, R. R. Neptune, and G. K. Klute, “Influence of prosthetic foot selection on walking performance during various load carriage conditions,” Clinical Biomechanics, vol. 122, p. 106440, Feb. 2025, doi: 10.1016/j.clinbiomech.2025.106440.
[31]A. Brandt, Y. Wen, M. Liu, J. Stallings, and H. H. Huang, “Interactions between transfemoral amputees and a powered knee prosthesis during load carriage,” Sci Rep, vol. 7, no. 1, p. 14480, Nov. 2017, doi: 10.1038/s41598-017-14834-7.
[32]J. I. E. Hoffman, Biostatistics for medical and biomedical practitioners. Amsterdam: Elsevier/Academic Press, 2015.
[33]S. J. Hillman et al., “Repeatability of a new observational gait score for unilateral lower limb amputees,” Gait & Posture, vol. 32, no. 1, pp. 39–45, 2010.
[34]K. R. Herrin, S. T. Kwak, C. G. Rock, and Y.-H. Chang, “Identifying gait quality metrics sensitive to changes in lower limb constraint,” Cogent Engineering, vol. 11, no. 1, p. 2312697, Dec. 2024, doi: 10.1080/23311916.2024.2312697.
[35]G. Borg, Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics, 1998.
[36]R. Soangra, H. Bhatt, and E. Rashedi, “Effects of load carriage and surface inclination on linear and non-linear postural variability,” Safety Science, vol. 110, pp. 427–437, Dec. 2018, doi: 10.1016/j.ssci.2018.03.019.
[37]K. Muslim and M. A. Nussbaum, “The effects of a simple intervention on exposures to low back pain risk factors during traditional posterior load carriage,” Applied Ergonomics, vol. 59, pp. 313–319, Mar. 2017, doi: 10.1016/j.apergo.2016.09.003.
[38]A. Hewson, S. Dent, and A. Sawers, “Strength deficits in lower limb prosthesis users: A scoping review,” Prosthetics & Orthotics International, vol. 44, no. 5, pp. 323–340, Oct. 2020, doi: 10.1177/0309364620930176.
[39]C. Leys and S. Schumann, “A nonparametric method to analyze interactions: The adjusted rank transform test,” Journal of Experimental Social Psychology, vol. 46, no. 4, pp. 684–688, Jul. 2010, doi: 10.1016/j.jesp.2010.02.007.
[40]K. K. Chui, M. Jorge, S.-C. Yen, and M. M. Lusardi, Orthotics and Prosthetics in Rehabilitation E-Book: Orthotics and Prosthetics in Rehabilitation E-Book. Elsevier Health Sciences, 2019.
[41]M. J. Highsmith, B. W. Schulz, S. Hart-Hughes, G. A. Latlief, and S. L. Phillips, “Differences in the spatiotemporal parameters of transtibial and transfemoral amputee gait,” JPO Journal of Prosthetics and Orthotics, vol. 22, no. 1, pp. 26–30, Jan. 2010, doi: 10.1097/JPO.0b013e3181cc0e34.
[42]T. M. Köhler, M. Bellmann, and S. Blumentritt, “Polycentric exoprosthetic knee joints – Extent of shortening during swing phase,” Canadian Prosthetics & Orthotics Journal, vol. 3, no. 1, article no. 5, Jul. 2020. doi: 10.33137/cpoj.v3i1.33768.
[43]S. Winiarski, A. Rutkowska-Kucharska, and M. Kowal, “Symmetry function – An effective tool for evaluating the gait symmetry of trans-femoral amputees,” Gait & Posture, vol. 90, pp. 9–15, Oct. 2021, doi: 10.1016/j.gaitpost.2021.07.021.
[44]A. Esquenazi, “Gait analysis in lower-limb amputation and prosthetic rehabilitation,” Physical Medicine and Rehabilitation Clinics of North America, vol. 25, no. 1, pp. 153–167, Feb. 2014, doi: 10.1016/j.pmr.2013.09.006.
[45]S.-T. Ko, F. Asplund, and B. Zeybek, “A scoping review of pressure measurements in prosthetic sockets of transfemoral amputees during ambulation: Key considerations for sensor design,” Sensors, vol. 21, no. 15, p. 5016, Jul. 2021, doi: 10.3390/s21155016.
[46]M. Kamali, M. T. Karimi, A. Eshraghi, and H. Omar, “Influential factors in stability of lower-limb amputees,” American Journal of Physical Medicine & Rehabilitation, vol. 92, no. 12, pp. 1110–1118, 2013.
[47]F. Gottschalk and M. Stills, “The biomechanics of trans-femoral amputation,” Prosthetics and Orthotics International, vol. 18, no. 1, pp. 12–17, 1994.
[48]S. L. Kapp, “Transfemoral socket design and suspension options,” Physical Medicine and Rehabilitation Clinics, vol. 11, no. 3, pp. 569–584, 2000.
[49]T. N. Templin, “The influence of load carriage and foot stiffness on knee joint loading and metabolic cost during amputee walking,” Ph.D. dissertation, University of Texas at Austin, Austin, TX, 2019.
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Jun 30, 2025
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K. Muslim, A. Shafira, R. R. Kurnianto, S. Mihardi, and A. P. Sutarto, “Enhancing Above-Knee Prosthetic Design for Inclusive Workplaces: Ergonomic Considerations in Manual Material Handling”, J. Optimasi Sist. Ind., vol. 24, no. 1, pp. 102–120, Jun. 2025.
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- Attribution (BY): You must give appropriate credit to the author(s) and JOSI as the original source of publication (including the article title, author(s) names, journal name, volume, issue, page numbers, year, and DOI), provide a link to the CC BY-NC-SA 4.0 license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial (NC): You may not use the material for commercial purposes.
- ShareAlike (SA): If you remix, transform, or build upon the material, you must distribute your contributions under the same CC BY-NC-SA 4.0 license as the original.
A link to the full license text should also be provided: https://creativecommons.org/licenses/by-nc-sa/4.0/
