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Tacca JR, Colvin ZA, Grabowski AM. Greater than recommended stiffness and power setting of a stance-phase powered leg prosthesis can improve step-to-step transition work and effective foot length ratio during walking in people with transtibial amputation. Front Bioeng Biotechnol 2024; 12:1336520. [PMID: 39011154 PMCID: PMC11246994 DOI: 10.3389/fbioe.2024.1336520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/05/2024] [Indexed: 07/17/2024] Open
Abstract
People with unilateral transtibial amputation (TTA) using a passive-elastic prosthesis exhibit lower positive affected leg trailing work (ALtrail Wpos) and a greater magnitude of negative unaffected leg leading work (ULlead Wneg) during walking than non-amputees, which may increase joint pain and osteoarthritis risk in the unaffected leg. People with TTA using a stance-phase powered prosthesis (e.g., BiOM, Ottobock, Duderstadt, Germany) walk with increased ALtrail Wpos and potentially decreased magnitude of ULlead Wneg compared to a passive-elastic prosthesis. The BiOM includes a passive-elastic prosthesis with a manufacturer-recommended stiffness category and can be tuned to different power settings, which may change ALtrail Wpos, ULlead Wneg, and the prosthesis effective foot length ratio (EFLR). Thirteen people with TTA walked using 16 different prosthetic stiffness category and power settings on a level treadmill at 0.75-1.75 m/s. We constructed linear mixed effects models to determine the effects of stiffness category and power settings on ALtrail Wpos, ULlead Wneg, and EFLR and hypothesized that decreased stiffness and increased power would increase ALtrail Wpos, not change and decrease ULlead Wneg magnitude, and decrease and not change prosthesis EFLR, respectively. We found there was no significant effect of stiffness category on ALtrail Wpos but increased stiffness reduced ULlead Wneg magnitude, perhaps due to a 0.02 increase in prosthesis EFLR compared to the least stiff category. Furthermore, we found that use of the BiOM with 10% and 20% greater than recommended power increased ALtrail Wpos and decreased ULlead Wneg magnitude at 0.75-1.00 m/s. However, prosthetic power setting depended on walking speed so that use of the BiOM increased ULlead Wneg magnitude at 1.50-1.75 m/s compared to a passive-elastic prosthesis. Ultimately, our results suggest that at 0.75-1.00 m/s, prosthetists should utilize the BiOM attached to a passive-elastic prosthesis with an increased stiffness category and power settings up to 20% greater than recommended based on biological ankle values. This prosthetic configuration can allow people with unilateral transtibial amputation to increase ALtrail Wpos and minimize ULlead Wneg magnitude, which could reduce joint pain and osteoarthritis risk in the unaffected leg and potentially lower the metabolic cost of walking.
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Affiliation(s)
- Joshua R Tacca
- Paul M. Rady Department of Mechanical Engineering, University of Colorado, Boulder, CO, United States
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States
| | - Zane A Colvin
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States
| | - Alena M Grabowski
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, CO, United States
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2
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Rahnama L, Soulis K, Geil MD. A review of evidence on mechanical properties of running specific prostheses and their relationship with running performance. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1402114. [PMID: 38962729 PMCID: PMC11220186 DOI: 10.3389/fresc.2024.1402114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
Background Although mechanical properties of running specific prostheses (RSPs) can affect running performance, manufacturers do not consistently report them. This study aimed to review existing literature on RSP mechanical and structural properties and their relationship with running performance. Methods A comprehensive search was conducted using keywords related to mechanical properties of RSPs and running performance. Search terms included stiffness and hysteresis, as well as performance outcomes including metabolic cost and running speed. Non-peer-reviewed and non-English publications were excluded. Results Twenty articles were included in the review. Sixteen studies used a material testing machine to measure RSP material properties, and four articles used other techniques including 2D/3D video capture and force platforms. Both measurement techniques and reporting of outcomes were inconsistent, which limits the ability to draw broad conclusions. Additionally, several studies did not report the numerical data for material properties despite measuring them. Relatively few articles measured both material properties and running performance and assessed correlations. Conclusion Several articles connected prosthesis properties to running performance. However, inconsistent measurement and reporting of mechanical properties, along with the multifactorial nature of the athlete-prosthesis system, limit the ability to draw broad conclusions regarding the relationship between material and structural properties and athlete performance. Current evidence may be useful for clinicians seeking ways to optimize RSP stiffness in a case-by-case basis; however, clinicians would benefit from more consistent and systematic comparisons of the attributes of different RSPs and their role in performance.
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Affiliation(s)
- Leila Rahnama
- Rongxiang Xu College of Health and Human Services, California State University, Los Angeles, Los Angeles, CA, United States
| | - Kimberly Soulis
- Employee Wellness Department, Wellstar Health System, Marietta, GA, United States
| | - Mark D. Geil
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, United States
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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Ghiami Rad A, Shahbazi B. A systematic investigation of sensorimotor mechanisms with intelligent prostheses in patients with ankle amputation while walking. J Mech Behav Biomed Mater 2024; 151:106357. [PMID: 38181570 DOI: 10.1016/j.jmbbm.2023.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024]
Abstract
It is thought that creating sensorimotor feedback in people with ankle joint amputation can affect motor biomechanics during gait, but there is little evidence or previous research. This study e aim ed to investigate the sensorimotor mechanism of smart prostheses in with ankle amputations while walking. Search in Google Scholar, Scopus, PubMed and Medline databases between April 2017 and February 2023, in addition to a detailed review in specialized clinical and engineering databases, 29 articles were selected based on the inclusion and exclusion criteria. Trials that mainly include; Proprioception, walking process in movement disorders, ankle amputation were included. Qualitative assessments of selected trials using PEDro' scale was used. The review of studies showed that the use of pressure sensors, neural stimulation through encoded algorithms can provide continuous tactile and positional information of the artificial leg in the direction of neural stimulation throughout the entire walking cycle. These findings indicate that restoration of intraneuronal sensory feedback leads to functional and cognitive benefits. With these definitions, different companies and research centers are trying to improve the mechanics of walking, however, movement strategies are unknown despite little research in creating sense and movement in the use of smart prostheses.
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Affiliation(s)
- Amir Ghiami Rad
- Movement Biomechanics, Department of Movement Behavior, Faculty of Sports Sciences, University Of Tabriz, Tabriz, Iran.
| | - Behnam Shahbazi
- Movement Biomechanics, Department of Sports Biomechanics, Faculty of Sports Sciences, Bu- Ali Sina University, Hamadan, Iran.
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Ármannsdóttir AL, Lecomte C, Lemaire E, Brynjólfsson S, Briem K. Perceptions and biomechanical effects of varying prosthetic ankle stiffness during uphill walking: A case series. Gait Posture 2024; 108:354-360. [PMID: 38227995 DOI: 10.1016/j.gaitpost.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Prosthetic foot stiffness, which is typically invariable for commercially available prosthetic feet, needs to be considered when prescribing a prosthetic foot. While a biological foot adapts its function according to the movement task, an individual with lower limb amputation may be limited during more functionally demanding gait tasks by their conventional energy storing and return prosthetic foot. RESEARCH QUESTION How do changes in prosthetic foot stiffness during incline walking affect biomechanical measures as well as perception of participants. METHODS Kinetic and kinematic data were collected during incline walking, for five participants with trans-tibial amputation. A mixed model analysis of variance was used to analyse the effects of changing the stiffness during incline walking, using a novel variable-stiffness unit built on a commercially available prosthetic foot. Biomechanical results were also analysed on an individual level alongside the participant feedback, for a better understanding of the various strategies and perceptions exhibited during incline walking. RESULTS Statistically significant effects were only observed on the biomechanical parameters directly related to prosthetic ankle kinematics and kinetics (i.e., peak prosthetic ankle dorsiflexion, peak prosthetic ankle power, dynamic joint stiffness during controlled dorsiflexion). Participant perception during walking was affected by changes in stiffness. Individual analyses revealed varied perceptions and varied biomechanical responses among participants. SIGNIFICANCE While changes in prosthesis mechanical properties influenced the amputee's experience, minimal immediate effects were found with the overall gait pattern. The reported inter-participant variability may be due to the person's physical characteristics or habitual gait pattern, which may influence prosthesis function. The ability to vary prosthetic foot stiffness during the assessment phase of setting up a prosthesis could provide useful information to guide selection of the appropriate prosthetic device for acceptable performance across a range of activities.
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Affiliation(s)
- Anna Lára Ármannsdóttir
- Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland; Össur hf., Grjótháls 5, 110 Reykjavik, Iceland.
| | - Christophe Lecomte
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland; Össur hf., Grjótháls 5, 110 Reykjavik, Iceland
| | - Edward Lemaire
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sigurður Brynjólfsson
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | - Kristín Briem
- Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
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6
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Naseri A, Lee IC, Huang H, Liu M. Investigating the Association of Quantitative Gait Stability Metrics With User Perception of Gait Interruption Due to Control Faults During Human-Prosthesis Interaction. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4693-4702. [PMID: 37906490 DOI: 10.1109/tnsre.2023.3328877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
This study aims to compare the association of different gait stability metrics with the prosthesis users' perception of their own gait stability. Lack of perceived confidence on the device functionality can influence the gait pattern, level of daily activities, and overall quality of life for individuals with lower limb motor deficits. However, the perception of gait stability is subjective and difficult to acquire online. The quantitative gait stability metrics can be objectively measured and monitored using wearable sensors; however, objective measurements of gait stability associated with human's perception of their own gait stability has rarely been reported. By identifying quantitative measurements that associate with users' perceptions, we can gain a more accurate and comprehensive understanding of an individual's perceived functional outcomes of assistive devices such as prostheses. To achieve our research goal, experiments were conducted to artificially apply internal disturbances in the powered prosthesis while the prosthetic users performed level ground walking. We monitored and compared multiple gait stability metrics and a local measurement to the users' reported perception of their own gait stability. The results showed that the center of pressure progression in the sagittal plane and knee momentum (i.e., residual thigh and prosthesis shank angular momentum about prosthetic knee joint) can potentially estimate the users' perceptions of gait stability when experiencing disturbances. The findings of this study can help improve the development and evaluation of gait stability control algorithms in robotic prosthetic devices.
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Martulli LM, Sala R, Rollo G, Kostovic M, Lavorgna M, Sorrentino A, Gruppioni E, Bernasconi A. Preliminary Stiffness-Driven Redesign of a Laminated Prosthetic Component Using Additive Manufacturing. Polymers (Basel) 2023; 15:polym15020346. [PMID: 36679227 PMCID: PMC9865767 DOI: 10.3390/polym15020346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Three-dimensional printed polymers offer unprecedented advantages for prosthetic applications, namely in terms of affordability and customisation. This work thus investigates the possibility of designing an additively manufactured prosthetic foot using continuous fibre-reinforced polymers as an alternative to composite laminate ones. A numerical approach was thus proposed and validated as a possible design tool for additively manufactured composite feet. This approach was based on explicit separate simulations of the infill, aiming to capture its homogenised engineering constants. The approach was validated on simple sandwich specimens with a different infill geometry: stiffness predictions were within the experimental standard deviation for 3D simulations. Such an approach was thus applied to redesign a laminated component of a foot prosthesis inspired by a commercial one with new additive technology. The new component was about 83% thicker than the reference one, with 1.6 mm of glass fibre skins out of about 22 mm of the total thickness. Its stiffness was within 5% of the reference laminated one. Overall, this work showed how additive manufacturing could be used as a low-cost alternative to manufacturing affordable prosthetic feet.
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Affiliation(s)
- Luca Michele Martulli
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156 Milano, Italy
- Correspondence: (L.M.M.); (A.B.)
| | - Riccardo Sala
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156 Milano, Italy
| | - Gennaro Rollo
- National Research Council (CNR), Polymer, Composites and Biomaterials Institute, Via Previati 1/E, 23900 Lecco, LC, Italy
| | - Milutin Kostovic
- National Research Council (CNR), Polymer, Composites and Biomaterials Institute, Via Previati 1/E, 23900 Lecco, LC, Italy
| | - Marino Lavorgna
- National Research Council (CNR), Polymer, Composites and Biomaterials Institute, Via Previati 1/E, 23900 Lecco, LC, Italy
| | - Andrea Sorrentino
- National Research Council (CNR), Polymer, Composites and Biomaterials Institute, Via Previati 1/E, 23900 Lecco, LC, Italy
| | - Emanuele Gruppioni
- Istituto nazionale Assicurazione Infortuni sul Lavoro (INAIL), Centro Protesi Inail, Via Rabuina 14, 40054 Vigorso di Budrio, BO, Italy
| | - Andrea Bernasconi
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156 Milano, Italy
- Correspondence: (L.M.M.); (A.B.)
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Ruxin TR, Halsne EG, Turner AT, Curran CS, Caputo JM, Hansen AH, Hafner BJ, Morgenroth DC. Comparing forefoot and heel stiffnesses across commercial prosthetic feet manufactured for individuals with varying body weights and foot sizes. Prosthet Orthot Int 2022; 46:425-431. [PMID: 35426860 DOI: 10.1097/pxr.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the effects of prosthetic foot mechanical properties on gait of people with lower limb amputation, scant forefoot and heel stiffness data exist to help guide prosthetic foot prescription. OBJECTIVE To measure forefoot and heel linear stiffness properties across commonly prescribed commercial prosthetic foot models and to describe variations in stiffness across feet targeted for users with different body weights and foot sizes. STUDY DESIGN Mechanical testing of five types of commercial prosthetic feet across nine user body weight and foot size combinations. METHODS Linear forefoot and heel stiffness (force vs. displacement) data were collected for 41 prosthetic feet. Quasistatic testing was conducted at -15 and +20 degrees to isolate loading of the heel and forefoot, respectively. RESULTS Overall, there was a significant relationship between user body weight and both forefoot and heel stiffness, when adjusted for foot size and type ( P < 0.001). However, there were a substantial number of inconsistencies across foot type within example user body weight and foot sizes combination. Furthermore, the relative order of forefoot stiffness across foot type differed from the relative order of heel stiffness across foot type. CONCLUSIONS The inconsistencies and differences in relative order of forefoot and heel stiffness across commercial foot type suggest the importance of publishing objective stiffness and other mechanical properties of prosthetic feet. These data can aid clinicians in better matching mechanical properties of prosthetic feet with the functional goals and abilities of prosthesis users.
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Affiliation(s)
- Talia R Ruxin
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Elizabeth G Halsne
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Anne T Turner
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Carl S Curran
- Human Motion Technologies LLC d/b/a Humotech, Pittsburgh, PA, USA
| | - Joshua M Caputo
- Human Motion Technologies LLC d/b/a Humotech, Pittsburgh, PA, USA
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Departments of Rehabilitation Medicine & Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - David C Morgenroth
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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9
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Foot contact forces can be used to personalize a wearable robot during human walking. Sci Rep 2022; 12:10947. [PMID: 35768457 PMCID: PMC9243054 DOI: 10.1038/s41598-022-14776-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
Individuals with below-knee amputation (BKA) experience increased physical effort when walking, and the use of a robotic ankle-foot prosthesis (AFP) can reduce such effort. The walking effort could be further reduced if the robot is personalized to the wearer using human-in-the-loop (HIL) optimization of wearable robot parameters. The conventional physiological measurement, however, requires a long estimation time, hampering real-time optimization due to the limited experimental time budget. This study hypothesized that a function of foot contact force, the symmetric foot force-time integral (FFTI), could be used as a cost function for HIL optimization to rapidly estimate the physical effort of walking. We found that the new cost function presents a reasonable correlation with measured metabolic cost. When we employed the new cost function in HIL ankle-foot prosthesis stiffness parameter optimization, 8 individuals with simulated amputation reduced their metabolic cost of walking, greater than 15% (p < 0.02), compared to the weight-based and control-off conditions. The symmetry cost using the FFTI percentage was lower for the optimal condition, compared to all other conditions (p < 0.05). This study suggests that foot force-time integral symmetry using foot pressure sensors can be used as a cost function when optimizing a wearable robot parameter.
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Halsne EG, Curran C, Caputo JM, Hansen A, Hafner BJ, Morgenroth D. Emulating the Effective Ankle Stiffness of Commercial Prosthetic Feet Using a Robotic Prosthetic Foot Emulator. J Biomech Eng 2022; 144:1141731. [PMID: 35722979 DOI: 10.1115/1.4054834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/08/2022]
Abstract
Prosthetic foot selection for individuals with lower limb amputation relies primarily on clinician judgment. The prosthesis user rarely has an opportunity to provide experiential input into the decision by trying different feet. A prosthetic foot emulator (PFE) is a robotic prosthetic foot that could facilitate prosthesis users' ability to trial feet with different mechanical characteristics. Here, we introduce a procedure by which a robotic PFE is configured to emulate the sagittal plane effective ankle stiffness of a range of commercial prosthetic forefeet. Mechanical testing was used to collect data on five types of commercial prosthetic feet across a range of foot sizes and intended user body weights. Emulated forefoot profiles were parameterized using Bezier curve fitting on ankle torque-angle data. Mechanical testing was repeated with the PFE, across a subset of emulated foot conditions, to assess the accuracy of the emulation. Linear mixed-effects regression and Bland-Altman Limits of Agreement analyses were used to compare emulated and commercial ankle torque-angle data. Effective ankle stiffness of the emulated feet was significantly associated with the corresponding commercial prosthetic feet (p<.001). On average, the emulated forefeet reproduced the effective ankle stiffness of corresponding commercial feet within 1%. Furthermore, differences were independent of prosthetic foot type, foot size, or user body weight. These findings suggest a PFE could be an effective tool for emulating commercial prosthetic feet, enabling prosthesis users to quickly trial different feet and provide experiential input as part of a prosthetic foot prescription.
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Affiliation(s)
- Elizabeth G Halsne
- Center for Limb Loss and Mobility, VA Puget Sound Health Care System, 1660 S Columbian Way (MS 151), Seattle, WA 98108; Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195
| | - Carl Curran
- Human Motion Technologies LLC d/b/a Humotech, 630 William Pitt Way, U-PARC, Building A2, Pittsburgh, PA 15238
| | - Joshua M Caputo
- Human Motion Technologies LLC d/b/a Humotech, 630 William Pitt Way, U-PARC, Building A2, Pittsburgh, PA 15238
| | - Andrew Hansen
- Minneapolis Adaptive Design & Engineering (MADE) Program, Minneapolis VA Health Care System, 1 Veterans Dr (MS 151), Minneapolis, MN 55417; Departments of Rehabilitation Medicine & Biomedical Engineering, University of Minnesota, Rehabilitation Science Program, MMC 388, 420 Delaware St. SE, Minneapolis, MN 55455
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195
| | - David Morgenroth
- Center for Limb Loss and Mobility, VA Puget Sound Health Care System, 1660 S Columbian Way (MS 151), Seattle, WA 98108; Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195
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11
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Turner AT, Halsne EG, Caputo JM, Curran CS, Hansen AH, Hafner BJ, Morgenroth DC. Prosthetic forefoot and heel stiffness across consecutive foot stiffness categories and sizes. PLoS One 2022; 17:e0268136. [PMID: 35536854 PMCID: PMC9089881 DOI: 10.1371/journal.pone.0268136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Prosthetic foot stiffness plays a key role in the functional mobility of lower limb prosthesis users. However, limited objective data exists to guide selection of the optimal prosthetic foot stiffness category for a given individual. Clinicians often must rely solely on manufacturer recommendations, which are typically based on the intended user’s weight and general activity level. Availability of comparable forefoot and heel stiffness data would allow for a better understanding of differences between different commercial prosthetic feet, and also between feet of different stiffness categories and foot sizes. Therefore, this study compared forefoot and heel linear stiffness properties across manufacturer-designated stiffness categories and foot sizes. Mechanical testing was completed for five types of commercial prosthetic feet across a range of stiffness categories and three foot-sizes. Data were collected for 56 prosthetic feet, in total. Testing at two discrete angles was conducted to isolate loading of the heel and forefoot components, respectively. Each prosthetic foot was loaded for six cycles while force and displacement data were collected. Forefoot and heel measured stiffness were both significantly associated with stiffness category (p = .001). There was no evidence that the relationships between stiffness category and measured stiffness differed by foot size (stiffness category by size interaction p = .80). However, there were inconsistencies between the expected and measured stiffness changes across stiffness categories (i.e., magnitude of stiffness changes varied substantially between consecutive stiffness categories of the same feet). While statistical results support that, on average, measured stiffness is positively correlated with stiffness category, force-displacement data suggest substantial variation in measured stiffness across consecutive categories. Published objective mechanical property data for commercial prosthetic feet would likely therefore be helpful to clinicians during prescription.
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Affiliation(s)
- Anne T. Turner
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, United States of America
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, United States of America
| | - Elizabeth G. Halsne
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Joshua M. Caputo
- Human Motion Technologies LLC d/b/a Humotech, Pittsburgh, Pennsylvania, United States of America
| | - Carl S. Curran
- Human Motion Technologies LLC d/b/a Humotech, Pittsburgh, Pennsylvania, United States of America
| | - Andrew H. Hansen
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - David C. Morgenroth
- VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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12
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Effects of shear force reduction during mechanical testing and day-to-day variation on stiffness of commercial prosthetic feet: a technical note. Prosthet Orthot Int 2022; 46:206-211. [PMID: 35412527 DOI: 10.1097/pxr.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mechanical testing is the principal method used to quantify properties of commercial prosthetic feet in a controlled and standardized manner. To test feet in a mechanical testing machine without overconstraining the system, tangential shear forces must be minimized. However, there is scant published information comparing techniques for reducing shear forces during mechanical testing. Furthermore, there are no data on variability in linear stiffness across testing sessions. OBJECTIVES To compare techniques for reducing shear forces during mechanical testing of prosthetic feet and to evaluate variation in linear stiffness across testing sessions. STUDY DESIGN Repeated measures. TECHNIQUE Force-displacement data were collected at two pylon progression angles, one for the forefoot and one for the heel, and compared across three conditions: roller plate (RoPl), low-friction interface on the shoe (SB), and no method for reducing shear forces (NoSB). Data were collected for a range of commercial prosthetic foot models and sizes. Select data were collected over multiple days to assess variation over test sessions. RESULTS Differences in stiffness between RoPl and SB test conditions ranged from -0.9% to +2.6% across foot models. By contrast, differences between RoPl and no method for reducing shear conditions ranged from -2.9% to +14.6%. Differences in linear stiffness between test sessions ranged from -2.2% to +3.6%. CONCLUSIONS Methods for reducing shear force in this study demonstrated roughly equivalent effects. Thus, a low-friction interface may be used as a less expensive and less complex method for reducing shear force in prosthetic foot testing. In addition, mechanical testing results were relatively consistent across multiple test sessions, lending confidence to test consistency.
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Mellema M, Gjøvaag T. Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:2243. [PMID: 35336412 PMCID: PMC8955603 DOI: 10.3390/s22062243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. METHODS The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. RESULTS AND CONCLUSIONS 98 articles met the inclusion criteria. According to the included studies' main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.
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Affiliation(s)
- Mirjam Mellema
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
| | - Terje Gjøvaag
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
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14
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Cavallaro L, Tessari F, Milandri G, De Benedictis C, Ferraresi C, Laffranchi M, De Michieli L. Finite element modeling of an energy storing and return prosthetic foot and implications of stiffness on rollover shape. Proc Inst Mech Eng H 2021; 236:218-227. [PMID: 34693815 DOI: 10.1177/09544119211044556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Energy storing and return (ESAR) prosthetic feet showed continuous improvements during the last 30 years. Despite this, standard guidelines are still missing to achieve an optimal foot design in terms of performances. One of the most important design parameters in ESAR feet is the Rollover Shape (RoS). This represents the foot Center of Pressure (CoP) path in a shank-based coordinate system during stance. RoS objectively describes the foot behavior according to its stiffness, which depends on foot geometry and material. This work presents the development of a finite element modeling methodology able to predict the stiffness characteristic of an ESAR foot and its RoS. The validation of the model is performed on a well-known commercially available prosthetic foot both in bench tests and realistic walking scenario. The obtained results confirm an error of +6.1% on stiffness estimation and +10.2% on RoS evaluation, which underlines that the proposed method is a powerful tool able to replicate the mechanical behavior of a prosthetic foot.
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Affiliation(s)
| | - Federico Tessari
- Rehab Technologies, Italian Institute of Technology, Genova, Italy.,Department of Mechanical and Aerospace Engineering, DIMEAS, Politecnico di Torino, Turin, Italy
| | | | - Carlo De Benedictis
- Department of Mechanical and Aerospace Engineering, DIMEAS, Politecnico di Torino, Turin, Italy
| | - Carlo Ferraresi
- Department of Mechanical and Aerospace Engineering, DIMEAS, Politecnico di Torino, Turin, Italy
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Berthaume MA, Kramer PA. Anthroengineering: an independent interdisciplinary field. Interface Focus 2021; 11:20200056. [PMID: 34938428 PMCID: PMC8361575 DOI: 10.1098/rsfs.2020.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 12/31/2022] Open
Abstract
In recent decades, funding agencies, institutes and professional bodies have recognized the profound benefits of transdisciplinarity in tackling targeted research questions. However, once questions are answered, the previously abundant support often dissolves. As such, the long-term benefits of these transdisciplinary approaches are never fully achieved. Over the last several decades, the integration of anthropology and engineering through inter- and multidisciplinary work has led to advances in fields such as design, human evolution and medical technologies. The lack of formal recognition, however, of this transdisciplinary approach as a unique entity rather than a useful tool or a subfield makes it difficult for researchers to establish laboratories, secure permanent jobs, fund long-term research programmes and train students in this approach. To facilitate the growth and development and witness the long-term benefits of this approach, we propose the integration of anthropology and engineering be recognized as a new, independent field known as anthroengineering. We present a working definition for anthroengineering and examples of how anthroengineering has been used. We discuss the necessity of recognizing anthroengineering as a unique field and explore potential novel applications. Finally, we discuss the future of anthroengineering, highlighting avenues for moving the field forward.
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Affiliation(s)
- Michael A. Berthaume
- Division of Mechanical Engineering and Design, London South Bank University, London SE1 0AA, UK
| | - Patricia Ann Kramer
- Department of Anthropology, University of Washington, Seattle, WA 98195-3100, USA
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195-3100, USA
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16
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Hammerberg AG, Kramer PA. Consistent inconsistencies in braking: a spatial analysis. Interface Focus 2021; 11:20200058. [PMID: 34938429 DOI: 10.1098/rsfs.2020.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/12/2022] Open
Abstract
The dynamic system that is the bipedal body in motion is of interest to engineers, clinicians and biological anthropologists alike. Spatial statistics is more familiar to public health researchers as a way of analysing disease clustering and spread; nonetheless, this is a practical approach to the two-dimensional topography of the foot. We quantified the clustering of the centre of pressure (CoP) on the foot for peak braking and propulsive vertical ground reaction forces (GRFs) over multiple, contiguous steps to assess the consistency of the location of peak forces on the foot during walking. The vertical GRFs of 11 participants were collected continuously via a wireless insole system (MoticonReGo AG) across various experimental conditions. We hypothesized that CoPs would cluster in the hindfoot for braking and forefoot for propulsion, and that braking would demonstrate more consistent clustering than propulsion. Contrary to our hypotheses, we found that CoPs during braking are inconsistent in their location, and CoPs during propulsion are more consistent and clustered across all participants and all trials. These results add to our understanding of the applied forces on the foot so that we can better predict fatigue failures and better understand the mechanisms that shaped the modern bipedal form.
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Affiliation(s)
- Alexandra G Hammerberg
- Primate Evolutionary Biomechanics Laboratory, University of Washington, Seattle, WA 98195-3100, USA
| | - Patricia Ann Kramer
- Primate Evolutionary Biomechanics Laboratory, University of Washington, Seattle, WA 98195-3100, USA
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17
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Ármannsdóttir AL, Lecomte C, Brynjólfsson S, Briem K. Task dependent changes in mechanical and biomechanical measures result from manipulating stiffness settings in a prosthetic foot. Clin Biomech (Bristol, Avon) 2021; 89:105476. [PMID: 34517194 DOI: 10.1016/j.clinbiomech.2021.105476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adaptation of lower limb function to different gait tasks is inherently not as effective among individuals with lower limb amputation as compared to able-bodied individuals. Varying stiffness of a prosthetic foot may be a way of facilitating gait tasks that require larger ankle joint range of motion. METHODS Three stiffness settings of a novel prosthetic foot design were tested for level walking at three speeds as well as for 7,5° incline and decline walking. Outcome measures, describing ankle range of motion and ankle dynamic joint stiffness were contrasted across the three stiffness settings. Standardized mechanical tests were done for the hindfoot and forefoot. FINDINGS Dorsiflexion angle was incrementally increased with a softer foot and a faster walking speed / higher degree of slope. The concurrent dynamic joint stiffness exhibited a less systematic change, especially during INCLINE and DECLINE walking. The small difference seen between the stiffness settings for hindfoot loading limits analysis for the effects of stiffness during weight acceptance, however, a stiffer foot significantly restricted plantarflexion during DECLINE. INTERPRETATIONS Varying stiffness settings within a prosthetic foot does have an effect on prosthetic foot dynamics, and differences are task dependent, specifically in parameters involving kinetic attributes. When considering the need for increased ankle range of motion while performing more demanding gait tasks, a foot that allows the users themselves to adjust stiffness according to the task at hand may be of benefit for active individuals, possibly enhancing the user's satisfaction and comfort during various daily activities.
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Affiliation(s)
- Anna L Ármannsdóttir
- Research Centre of Movement Science, University of Iceland, Sæmundargata 2, 102 Reykjavík, Iceland.
| | - Christophe Lecomte
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Sæmundargata 2, 102 Reykjavík, Iceland; Össur hf., Grjótháls 5, 110 Reykjavik, Iceland
| | | | - Kristín Briem
- Research Centre of Movement Science, University of Iceland, Sæmundargata 2, 102 Reykjavík, Iceland
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