A universal ankle-foot prosthesis emulator for human locomotion experiments

Energy neutral: the human foot and ankle subsections combine to produce near zero net mechanical work during walking

The human foot and ankle system is equipped with structures that can produce mechanical work through elastic (e.g., Achilles tendon, plantar fascia) or viscoelastic (e.g., heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution among various subsections of the foot and ankle can be difficult, in large part due to a lack of objective methods for partitioning the forces acting underneath the stance foot. In this study, we deconstructed the mechanical work production during barefoot walking in a segment-by-segment manner (hallux, forefoot, hindfoot, and shank). This was accomplished by isolating the forces acting within each foot segment through controlling the placement of the participants’ foot as it contacted a ground-mounted force platform. Combined with an analysis that incorporated non-rigid mechanics, we quantified the total work production distal to each of the four isolated segments. We found that various subsections within the foot and ankle showed disparate work distribution, particularly within structures distal to the hindfoot. When accounting for all sources of positive and negative work distal to the shank (i.e., ankle joint and all foot structures), these structures resembled an energy-neutral system that produced net mechanical work close to zero (−0.012 ± 0.054 J/kg).

Design of a lightweight, tethered, torque-controlled knee exoskeleton

Lower-limb exoskeletons show promise for improving gait rehabilitation for those with chronic gait abnormalities due to injury, stroke or other illness. We designed and built a tethered knee exoskeleton with a strong lightweight frame and comfortable, four-point contact with the leg. The device is structurally compliant in select directions, instrumented to measure joint angle and applied torque, and is lightweight (0.76 kg). The exoskeleton is actuated by two off-board motors. Closed loop torque control is achieved using classical proportional feedback control with damping injection in conjunction with iterative learning. We tested torque measurement accuracy and found root mean squared (RMS) error of 0.8 Nm with a max load of 62.2 Nm. Bandwidth was measured to be phase limited at 45 Hz when tested on a rigid test stand and 23 Hz when tested on a person's leg. During bandwidth tests peak extension torques were measured up to 50 Nm. Torque tracking was tested during walking on a treadmill at 1.25 m/s with peak flexion torques of 30 Nm. RMS torque tracking error averaged over a hundred steps was 0.91 Nm. We intend to use this knee exoskeleton to investigate robotic assistance strategies to improve gait rehabilitation and enhance human athletic ability.

Design and characterization of a torque-controllable actuator for knee assistance during sit-to-stand

Individuals with post-stroke hemiparesis often have difficulty standing out of a chair. One way to potentially improve sit-to-stand is to provide knee extension assistance using a powered knee exoskeleton. An exoskeleton providing unilateral, partial assistance during sit-to-stand would need to be torque-controllable. There are no knee exoskeletons on the market suitable for conducting experiments assisting stroke patients with sit-to-stand, so to enable such experiments a research device was developed. The purpose of this report is to present the design of a novel knee exoskeleton actuator that uses a fiberglass leaf spring in series to improve torque-controllability, and present a characterization of the actuator performance. The actuator is capable of the required torque and speed for sit-to-stand, has high bandwidth (25 Hz), low output impedance at low frequencies (<;0.5 Nm), and excellent torque tracking. An orthotic brace built upon this actuator will enable an in-depth study on the biomechanical effects of providing stroke subjects with knee extension assistance during sit-to-stand.

Continuous sweep versus discrete step protocols for studying effects of wearable robot assistance magnitude

BACKGROUND

Different groups developed wearable robots for walking assistance, but there is still a need for methods to quickly tune actuation parameters for each robot and population or sometimes even for individual users. Protocols where parameters are held constant for multiple minutes have traditionally been used for evaluating responses to parameter changes such as metabolic rate or walking symmetry. However, these discrete protocols are time-consuming. Recently, protocols have been proposed where a parameter is changed in a continuous way. The aim of the present study was to compare effects of continuously varying assistance magnitude with a soft exosuit against discrete step conditions.

METHODS

Seven participants walked on a treadmill wearing a soft exosuit that assists plantarflexion and hip flexion. In Continuous-up, peak exosuit ankle moment linearly increased from approximately 0 to 38% of biological moment over 10 min. Continuous-down was the opposite. In Discrete, participants underwent five periods of 5 min with steady peak moment levels distributed over the same range as Continuous-up and Continuous-down. We calculated metabolic rate for the entire Continuous-up and Continuous-down conditions and the last 2 min of each Discrete force level. We compared kinematics, kinetics and metabolic rate between conditions by curve fitting versus peak moment.

RESULTS

Reduction in metabolic rate compared to Powered-off was smaller in Continuous-up than in Continuous-down at most peak moment levels, due to physiological dynamics causing metabolic measurements in Continuous-up and Continuous-down to lag behind the values expected during steady-state testing. When evaluating the average slope of metabolic reduction over the entire peak moment range there was no significant difference between Continuous-down and Discrete. Attempting to correct the lag in metabolics by taking the average of Continuous-up and Continuous-down removed all significant differences versus Discrete. For kinematic and kinetic parameters, there were no differences between all conditions.

CONCLUSIONS

The finding that there were no differences in biomechanical parameters between all conditions suggests that biomechanical parameters can be recorded with the shortest protocol condition (i.e. single Continuous directions). The shorter time and higher resolution data of continuous sweep protocols hold promise for the future study of human interaction with wearable robots.

Control and Evaluation of a Powered Transfemoral Prosthesis for Stair Ascent

This paper assesses the metabolic effort exerted by three transfemoral amputees, when using a powered knee and ankle prosthesis for stair ascent, relative to ascending stairs with passive knee and ankle prostheses. The paper describes a controller that provides step-over stair ascent behavior reflective of healthy stair ascent biomechanics, and describes its implementation in a powered prosthesis prototype. Stair ascent experiments were performed with three unilateral transfemoral amputee subjects, comparing the oxygen consumption required to ascend stairs using the powered prosthesis (with a step-over gait), relative to using their daily-use energetically passive prostheses (with a step-to gait). Results indicate on average a 24% reduction in oxygen consumption and a 30% reduction in stair ascent timewhen using the powered prosthesis, relative to when using the passive prostheses. All subjects expressed a strong preference for ascending stairs using the powered prosthesis.

Adaptive Foot in Lower-Limb Prostheses

The human foot consists of complex sets of joints. The adaptive nature of the human foot enables it to be stable on any uneven surface. It is important to have such adaptive capabilities in the artificial prosthesis to achieve most of the essential movements for lower-limb amputees. However, many existing lower-limb prostheses lack the adaptive nature. This paper reviews lower-limb adaptive foot prostheses. In order to understand the design concepts of adaptive foot prostheses, the biomechanics of human foot have been explained. Additionally, the requirements and design challenges are investigated and presented. In this review, adaptive foot prostheses are classified according to actuation method. Furthermore, merits and demerits of present-day adaptive foot prostheses are presented based on the hardware construction. The hardware configurations of recent adaptive foot prostheses are analyzed and compared. At the end, potential future developments are highlighted.

The AMP-Foot 3, new generation propulsive prosthetic feet with explosive motion characteristics: design and validation

The last decades, rehabilitation has become a challenging context for mechatronical engineering. From the state-of-the-art it is seen that the field of prosthetics offers very promising perspectives to roboticist. Today’s prosthetic feet tend to improve amputee walking experience by delivering the necessary push-off forces while walking. Therefore, several new types of (compliant) actuators are developed in order to fulfill the torque and power requirements of a sound ankle-foot complex with minimized power consumption. At the Vrije Universiteit Brussel, the Robotics and Multibody Mechanics research group puts a lot of effort in the design and development of new bionic feet. In 2013, the Ankle Mimicking Prosthetic (AMP-) Foot 2, as a proof-of-concept, showed the advantage of using the explosive elastic actuator capable of delivering the full ankle torques (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm 120$$\end{document}±120 Nm) and power (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm 250$$\end{document}±250 W) with only a 60 W motor. In this article, the authors present the AMP-Foot 3, using an improved actuation method and using two locking mechanisms for improved energy storage during walking. The article focusses on the mechanical design of the device and validation of its working principle.

Simulating Ideal Assistive Devices to Reduce the Metabolic Cost of Running

Tools have been used for millions of years to augment the capabilities of the human body, allowing us to accomplish tasks that would otherwise be difficult or impossible. Powered exoskeletons and other assistive devices are sophisticated modern tools that have restored bipedal locomotion in individuals with paraplegia and have endowed unimpaired individuals with superhuman strength. Despite these successes, designing assistive devices that reduce energy consumption during running remains a substantial challenge, in part because these devices disrupt the dynamics of a complex, finely tuned biological system. Furthermore, designers have hitherto relied primarily on experiments, which cannot report muscle-level energy consumption and are fraught with practical challenges. In this study, we use OpenSim to generate muscle-driven simulations of 10 human subjects running at 2 and 5 m/s. We then add ideal, massless assistive devices to our simulations and examine the predicted changes in muscle recruitment patterns and metabolic power consumption. Our simulations suggest that an assistive device should not necessarily apply the net joint moment generated by muscles during unassisted running, and an assistive device can reduce the activity of muscles that do not cross the assisted joint. Our results corroborate and suggest biomechanical explanations for similar effects observed by experimentalists, and can be used to form hypotheses for future experimental studies. The models, simulations, and software used in this study are freely available at simtk.org and can provide insight into assistive device design that complements experimental approaches.

A Robotic Ankle–Foot Prosthesis With Active Alignment

An ankle–foot prosthesis designed to mimic the missing physiological limb generates a large sagittal moment during push off which must be transferred to the residual limb through the socket connection. The large moment is correlated with high internal socket pressures that are often a source of discomfort for the person with amputation, limiting prosthesis use. In this paper, the concept of active alignment is developed. Active alignment realigns the affected residual limb toward the center of pressure (CoP) during stance. During gait, the prosthesis configuration changes to shorten the moment arm between the ground reaction force (GRF) and the residual limb. This reduces the peak moment transferred through the socket interface during late stance. A tethered robotic ankle prosthesis has been developed, and evaluation results are presented for active alignment during normal walking in a laboratory setting. Preliminary testing was performed with a subject without amputation walking with able-bodied adapters at a constant speed. The results show a 33% reduction in the peak resultant moment transferred at the socket limb interface.

Simulation-Based Design for Wearable Robotic Systems: An Optimization Framework for Enhancing a Standing Long Jump

GOAL

Technologies that augment human performance are the focus of intensive research and development, driven by advances in wearable robotic systems. Success has been limited by the challenge of understanding human-robot interaction. To address this challenge, we developed an optimization framework to synthesize a realistic human standing long jump and used the framework to explore how simulated wearable robotic devices might enhance jump performance.

METHODS

A planar, five-segment, seven-degree-of-freedom model with physiological torque actuators, which have variable torque capacity depending on joint position and velocity, was used to represent human musculoskeletal dynamics. An active augmentation device was modeled as a torque actuator that could apply a single pulse of up to 100 Nm of extension torque. A passive design was modeled as rotational springs about each lower limb joint. Dynamic optimization searched for physiological and device actuation patterns to maximize jump distance.

RESULTS

Optimization of the nominal case yielded a 2.27 m jump that captured salient kinematic and kinetic features of human jumps. When the active device was added to the ankle, knee, or hip, jump distance increased to between 2.49 and 2.52 m. Active augmentation of all three joints increased the jump distance to 3.10 m. The passive design increased jump distance to 3.32 m by adding torques of 135, 365, and 297 Nm to the ankle, knee, and hip, respectively.

CONCLUSION

Dynamic optimization can be used to simulate a standing long jump and investigate human-robot interaction.

SIGNIFICANCE

Simulation can aid in the design of performance-enhancing technologies.

Neural Data-Driven Musculoskeletal Modeling for Personalized Neurorehabilitation Technologies

OBJECTIVES

The development of neurorehabilitation technologies requires the profound understanding of the mechanisms underlying an individual's motor ability and impairment. A major factor limiting this understanding is the difficulty of bridging between events taking place at the neurophysiologic level (i.e., motor neuron firings) with those emerging at the musculoskeletal level (i.e. joint actuation), in vivo in the intact moving human. This review presents emerging model-based methodologies for filling this gap that are promising for developing clinically viable technologies.

METHODS

We provide a design overview of musculoskeletal modeling formulations driven by recordings of neuromuscular activity with a critical comparison to alternative model-free approaches in the context of neurorehabilitation technologies. We present advanced electromyography-based techniques for interfacing with the human nervous system and model-based techniques for translating the extracted neural information into estimates of motor function.

RESULTS

We introduce representative application areas where modeling is relevant for accessing neuromuscular variables that could not be measured experimentally. We then show how these variables are used for designing personalized rehabilitation interventions, biologically inspired limbs, and human-machine interfaces.

CONCLUSION

The ability of using electrophysiological recordings to inform biomechanical models enables accessing a broader range of neuromechanical variables than analyzing electrophysiological data or movement data individually. This enables understanding the neuromechanical interplay underlying in vivo movement function, pathology, and robot-assisted motor recovery.

SIGNIFICANCE

Filling the gap between our understandings of movement neural and mechanical functions is central for addressing one of the major challenges in neurorehabilitation: personalizing current technologies and interventions to an individual's anatomy and impairment.

Evaluation of the Achilles Ankle Exoskeleton

This paper evaluates the Achilles exoskeleton. The exoskeleton is intended to provide push-off assistance for healthy subjects during walking. The assistance is provided by a series elastic actuator that has been optimized to provide maximal push-off power. The paper presents the control method of the exoskeleton and the evaluation of the exoskeleton.

Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs

Robotic lower limb prostheses can improve the quality of life for amputees. Development of such devices, currently dominated by long prototyping periods, could be sped up by predictive simulations. In contrast to some amputee simulations which track experimentally determined non-amputee walking kinematics, here, we explicitly model the human-prosthesis interaction to produce a prediction of the user’s walking kinematics. We obtain simulations of an amputee using an ankle-foot prosthesis by simultaneously optimizing human movements and prosthesis actuation, minimizing a weighted sum of human metabolic and prosthesis costs. The resulting Pareto optimal solutions predict that increasing prosthesis energy cost, decreasing prosthesis mass, and allowing asymmetric gaits all decrease human metabolic rate for a given speed and alter human kinematics. The metabolic rates increase monotonically with speed. Remarkably, by performing an analogous optimization for a non-amputee human, we predict that an amputee walking with an appropriately optimized robotic prosthesis can have a lower metabolic cost – even lower than assuming that the non-amputee’s ankle torques are cost-free.

An experimental comparison of the relative benefits of work and torque assistance in ankle exoskeletons

Techniques proposed for assisting locomotion with exoskeletons have often included a combination of active work input and passive torque support, but the physiological effects of different assistance techniques remain unclear. We performed an experiment to study the independent effects of net exoskeleton work and average exoskeleton torque on human locomotion. Subjects wore a unilateral ankle exoskeleton and walked on a treadmill at 1.25 m·s(-1) while net exoskeleton work rate was systematically varied from -0.054 to 0.25 J·kg(-1)·s(-1), with constant (0.12 N·m·kg(-1)) average exoskeleton torque, and while average exoskeleton torque was systematically varied from approximately zero to 0.18 N·m·kg(-1), with approximately zero net exoskeleton work. We measured metabolic rate, center-of-mass mechanics, joint mechanics, and muscle activity. Both techniques reduced effort-related measures at the assisted ankle, but this form of work input reduced metabolic cost (-17% with maximum net work input) while this form of torque support increased metabolic cost (+13% with maximum average torque). Disparate effects on metabolic rate seem to be due to cascading effects on whole body coordination, particularly related to assisted ankle muscle dynamics and the effects of trailing ankle behavior on leading leg mechanics during double support. It would be difficult to predict these results using simple walking models without muscles or musculoskeletal models that assume fixed kinematics or kinetics. Data from this experiment can be used to improve predictive models of human neuromuscular adaptation and guide the design of assistive devices.

Informing Ankle-Foot Prosthesis Prescription through Haptic Emulation of Candidate Devices

Robotic prostheses can improve walking performance for amputees, but prescription of these devices has been hindered by their high cost and uncertainty about the degree to which individuals will benefit. The typical prescription process cannot well predict how an individual will respond to a device they have never used because it bases decisions on subjective assessment of an individual's current activity level. We propose a new approach in which individuals 'test drive' candidate devices using a prosthesis emulator while their walking performance is quantitatively assessed and results are distilled to inform prescription. In this system, prosthesis behavior is controlled by software rather than mechanical implementation, so users can quickly experience a broad range of devices. To test the viability of the approach, we developed a prototype emulator and assessment protocol, leveraging hardware and methods we previously developed for basic science experiments. We demonstrated emulations across the spectrum of commercially available prostheses, including traditional (e.g. SACH), dynamic-elastic (e.g. FlexFoot), and powered robotic (e.g. BiOM^® T2) prostheses. Emulations exhibited low error with respect to reference data and provided subjectively convincing representations of each device. We demonstrated an assessment protocol that differentiated device classes for each individual based on quantitative performance metrics, providing feedback that could be used to make objective, personalized device prescriptions.

Once-per-step control of ankle-foot prosthesis push-off work reduces effort associated with balance during walking

Background

Individuals with below-knee amputation have more difficulty balancing during walking, yet few studies have explored balance enhancement through active prosthesis control. We previously used a dynamical model to show that prosthetic ankle push-off work affects both sagittal and frontal plane dynamics, and that appropriate step-by-step control of push-off work can improve stability. We hypothesized that this approach could be applied to a robotic prosthesis to partially fulfill the active balance requirements of human walking, thereby reducing balance-related activity and associated effort for the person using the device.

Methods

We conducted experiments on human participants (N = 10) with simulated amputation. Prosthetic ankle push-off work was varied on each step in ways expected to either stabilize, destabilize or have no effect on balance. Average ankle push-off work, known to affect effort, was kept constant across conditions. Stabilizing controllers commanded more push-off work on steps when the mediolateral velocity of the center of mass was lower than usual at the moment of contralateral heel strike. Destabilizing controllers enforced the opposite relationship, while a neutral controller maintained constant push-off work regardless of body state. A random disturbance to landing foot angle and a cognitive distraction task were applied, further challenging participants’ balance. We measured metabolic rate, foot placement kinematics, center of pressure kinematics, distraction task performance, and user preference in each condition. We expected the stabilizing controller to reduce active control of balance and balance-related effort for the user, improving user preference.

Results

The best stabilizing controller lowered metabolic rate by 5.5% (p = 0.003) and 8.5% (p = 0.02), and step width variability by 10.0% (p = 0.009) and 10.7% (p = 0.03) compared to conditions with no control and destabilizing control, respectively. Participants tended to prefer stabilizing controllers. These effects were not due to differences in average push-off work, which was unchanged across conditions, or to average gait mechanics, which were also unchanged. Instead, benefits were derived from step-by-step adjustments to prosthesis behavior in response to variations in mediolateral velocity at heel strike.

Conclusions

Once-per-step control of prosthetic ankle push-off work can reduce both active control of foot placement and balance-related metabolic energy use during walking.

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-015-0027-3) contains supplementary material, which is available to authorized users.

The correlation between metabolic and individual leg mechanical power during walking at different slopes and velocities

During level-ground walking, mechanical work from each leg is required to redirect and accelerate the center of mass. Previous studies show a linear correlation between net metabolic power and the rate of step-to-step transition work during level-ground walking with changing step lengths. However, correlations between metabolic power and individual leg power during step-to-step transitions while walking on uphill/downhill slopes and at different velocities are not known. This basic understanding of these relationships between metabolic demands and biomechanical tasks can provide important information for design and control of biomimetic assistive devices such as leg prostheses and orthoses. Thus, we compared changes in metabolic power and mechanical power during step-to-step transitions while 19 subjects walked at seven slopes (0°, +/-3°, +/-6°, and +/-9°) and three velocities (1.00, 1.25, and 1.50m/s). A quadratic model explained more of the variance (R(2)=0.58-0.61) than a linear model (R(2)=0.37-0.52) between metabolic power and individual leg mechanical power during step-to-step transitions across all velocities. A quadratic model explained more of the variance (R(2)=0.57-0.76) than a linear model (R(2)=0.52-0.59) between metabolic power and individual leg mechanical power during step-to-step transitions at each velocity for all slopes, and explained more of the variance (R(2)=0.12-0.54) than a linear model (R(2)=0.07-0.49) at each slope for all velocities. Our results suggest that it is important to consider the mechanical function of each leg in the design of biomimetic assistive devices aimed at reducing metabolic costs when walking at different slopes and velocities.

A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study

Background

In persons post-stroke, diminished ankle joint function can contribute to inadequate gait propulsion. To target paretic ankle impairments, we developed a neuromechanics-based powered ankle exoskeleton. Specifically, this exoskeleton supplies plantarflexion assistance that is proportional to the user’s paretic soleus electromyography (EMG) amplitude only during a phase of gait when the stance limb is subjected to an anteriorly directed ground reaction force (GRF). The purpose of this feasibility study was to examine the short-term effects of the powered ankle exoskeleton on the mechanics and energetics of gait.

Methods

Five subjects with stroke walked with a powered ankle exoskeleton on the paretic limb for three 5 minute sessions. We analyzed the peak paretic ankle plantarflexion moment, paretic ankle positive work, symmetry of GRF propulsion impulse, and net metabolic power.

Results

The exoskeleton increased the paretic plantarflexion moment by 16% during the powered walking trials relative to unassisted walking condition (p < .05). Despite this enhanced paretic ankle moment, there was no significant increase in paretic ankle positive work, or changes in any other mechanical variables with the powered assistance. The exoskeleton assistance appeared to reduce the net metabolic power gradually with each 5 minute repetition, though no statistical significance was found. In three of the subjects, the paretic soleus activation during the propulsion phase of stance was reduced during the powered assistance compared to unassisted walking (35% reduction in the integrated EMG amplitude during the third powered session).

Conclusions

This feasibility study demonstrated that the exoskeleton can enhance paretic ankle moment. Future studies with greater sample size and prolonged sessions are warranted to evaluate the effects of the powered ankle exoskeleton on overall gait outcomes in persons post-stroke.

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-015-0015-7) contains supplementary material, which is available to authorized users.

The influence of push-off timing in a robotic ankle-foot prosthesis on the energetics and mechanics of walking

BACKGROUND

Robotic ankle-foot prostheses that provide net positive push-off work can reduce the metabolic rate of walking for individuals with amputation, but benefits might be sensitive to push-off timing. Simple walking models suggest that preemptive push-off reduces center-of-mass work, possibly reducing metabolic rate. Studies with bilateral exoskeletons have found that push-off beginning before leading leg contact minimizes metabolic rate, but timing was not varied independently from push-off work, and the effects of push-off timing on biomechanics were not measured. Most lower-limb amputations are unilateral, which could also affect optimal timing. The goal of this study was to vary the timing of positive prosthesis push-off work in isolation and measure the effects on energetics, mechanics and muscle activity.

METHODS

We tested 10 able-bodied participants walking on a treadmill at 1.25 m · s(-1). Participants wore a tethered ankle-foot prosthesis emulator on one leg using a rigid boot adapter. We programmed the prosthesis to apply torque bursts that began between 46% and 56% of stride in different conditions. We iteratively adjusted torque magnitude to maintain constant net positive push-off work.

RESULTS

When push-off began at or after leading leg contact, metabolic rate was about 10% lower than in a condition with Spring-like prosthesis behavior. When push-off began before leading leg contact, metabolic rate was not different from the Spring-like condition. Early push-off led to increased prosthesis-side vastus medialis and biceps femoris activity during push-off and increased variability in step length and prosthesis loading during push-off. Prosthesis push-off timing had no influence on intact-side leg center-of-mass collision work.

CONCLUSIONS

Prosthesis push-off timing, isolated from push-off work, strongly affected metabolic rate, with optimal timing at or after intact-side heel contact. Increased thigh muscle activation and increased human variability appear to have caused the lack of reduction in metabolic rate when push-off was provided too early. Optimal timing with respect to opposite heel contact was not different from normal walking, but the trends in metabolic rate and center-of-mass mechanics were not consistent with simple model predictions. Optimal push-off timing should also be characterized for individuals with amputation, since meaningful benefits might be realized with improved timing.

Prosthetic ankle push-off work reduces metabolic rate but not collision work in non-amputee walking

Individuals with unilateral below-knee amputation expend more energy than non-amputees during walking and exhibit reduced push-off work and increased hip work in the affected limb. Simple dynamic models of walking suggest a possible solution, predicting that increasing prosthetic ankle push-off should decrease leading limb collision, thereby reducing overall energy requirements. We conducted a rigorous experimental test of this idea wherein ankle-foot prosthesis push-off work was incrementally varied in isolation from one-half to two-times normal levels while subjects with simulated amputation walked on a treadmill at 1.25 m·s⁻¹. Increased prosthesis push-off significantly reduced metabolic energy expenditure, with a 14% reduction at maximum prosthesis work. In contrast to model predictions, however, collision losses were unchanged, while hip work during swing initiation was decreased. This suggests that powered ankle push-off reduces walking effort primarily through other mechanisms, such as assisting leg swing, which would be better understood using more complete neuromuscular models.