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

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

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.

Distribution of joint work during walking on slopes among persons with transfemoral amputation

Persons with above-knee amputation have increased energy consumption and greater difficulty in negotiating uphill and downhill slopes. Walking on slopes requires an adaptation of the positive and negative work performed by the joints of the lower limb to propel the center of mass. Modern prosthetic feet and knees can only partially adapt to changes in inclination, and the redistribution of joint work among persons with above-knee amputation is not described in the literature. Level, upslope and downslope walking (at 5% and 12% inclinations) were investigated for twelve subjects with transfemoral amputation fitted with an Energy Storing And Return foot (ESAR) and a Microprocessor controlled Prosthetic Knee (MPK) versus a control group of seventeen asymptomatic subjects. Lower limb joint and individual limb power and work were compared between prosthetic, contralateral and control limbs. The prosthesis dissipates less energy than the joints of the lower limb of the control group when descending the slope, but the demand on the contralateral limb is limited by a lower speed and step length. The huge deficit of positive work produced by the prosthetic ankle cannot be compensated by the residual hip during level and slope ascent which transfers the demand for energy production to the contralateral limb up to 40% on a 12% slope. This study highlights that prosthetic devices (ESAR foot and MPK) for persons with above-knee amputation present some limitations during slope walking that cannot be compensated by the residual hip and increase the work performed by the contralateral limb.

Economical and preferred walking speed using body weight support apparatus with a spring-like characteristics

BACKGROUND

A specific walking speed minimizing the U-shaped relationship between energy cost of transport per unit distance (CoT) and speed is called economical speed (ES). To investigate the effects of reduced body weight on the ES, we installed a body weight support (BWS) apparatus with a spring-like characteristics. We also examined whether the 'calculated' ES was equivalent to the 'preferred' walking speed (PWS) with 30% BWS.

METHODS

We measured oxygen uptake and carbon dioxide output to calculate CoT values at seven treadmill walking speeds (0.67-2.00 m s^- 1) in 40 healthy young males under normal walking (NW) and BWS. The PWS was determined under both conditions on a different day.

RESULTS

A spring-like behavior of our BWS apparatus reduced the CoT values at 1.56, 1.78, and 2.00 m s^- 1. The ES with BWS (1.61 ± 0.11 m s^- 1) was faster than NW condition (1.39 ± 0.06 m s^- 1). A Bland-Altman analysis indicated that there were no systematic biases between ES and PWS in both conditions.

CONCLUSIONS

The use of BWS apparatus with a spring-like behavior reduced the CoT values at faster walking speeds, resulting in the faster ES with 30% BWS compared to NW. Since the ES was equivalent to the PWS in both conditions, the PWS could be mainly determined by the metabolic minimization in healthy young males. This result also derives that the PWS can be a substitutable index of the individual ES in these populations.

Speed-related but not detrended gait variability increases with more sensitive self-paced treadmill controllers at multiple slopes

Self-paced treadmills are being used more frequently to study humans walking with their self-selected gaits on a range of slopes. There are multiple options to purchase a treadmill with a built-in controller, or implement a custom written self-paced controller, which raises questions about how self-paced controller affect treadmill speed and gait biomechanics on multiple slopes. This study investigated how different self-paced treadmill controller sensitivities affected gait parameters and variability on decline, level, and incline slopes. We hypothesized that increasing self-paced controller sensitivity would increase gait variability on each slope. We also hypothesized that detrended variability could help mitigate differences in variability that arise from differences in speed fluctuations created by the self-paced controllers. Ten young adults walked on a self-paced treadmill using three controller sensitivities (low, medium, and high) and fixed speeds at three slopes (decline, -10°; level, 0°; incline, +10°). Within each slope, average walking speeds and spatiotemporal gait parameters were similar regardless of self-paced controller sensitivity. With higher controller sensitivities on each slope, speed fluctuations, speed variance, and step length variance increased whereas step frequency variance and step width variance were unaffected. Detrended variance was not affected by controller sensitivity suggesting that detrending variability helps mitigate differences associated with treadmill speed fluctuations. Speed-trend step length variances, however, increased with more sensitive controllers. Further, detrended step length variances were similar for self-paced and fixed speed walking, whereas self-paced walking included substantial speed-trend step length variance not present in fixed speed walking. In addition, regardless of the self-paced controller, subjects walked fastest on the level slope with the longest steps, narrowest steps, and least variance. Overall, our findings suggest that separating gait variability into speed-trend and detrended variability could be beneficial for interpreting gait variability among multiple self-paced treadmill studies and when comparing self-paced walking with fixed speed walking.

Mechanics of walking and running up and downhill: A joint-level perspective to guide design of lower-limb exoskeletons

Lower-limb wearable robotic devices can improve clinical gait and reduce energetic demand in healthy populations. To help enable real-world use, we sought to examine how assistance should be applied in variable gait conditions and suggest an approach derived from knowledge of human locomotion mechanics to establish a 'roadmap' for wearable robot design. We characterized the changes in joint mechanics during walking and running across a range of incline/decline grades and then provide an analysis that informs the development of lower-limb exoskeletons capable of operating across a range of mechanical demands. We hypothesized that the distribution of limb-joint positive mechanical power would shift to the hip for incline walking and running and that the distribution of limb-joint negative mechanical power would shift to the knee for decline walking and running. Eight subjects (6M,2F) completed five walking (1.25 m s-1) trials at -8.53°, -5.71°, 0°, 5.71°, and 8.53° grade and five running (2.25 m s-1) trials at -5.71°, -2.86°, 0°, 2.86°, and 5.71° grade on a treadmill. We calculated time-varying joint moment and power output for the ankle, knee, and hip. For each gait, we examined how individual limb-joints contributed to total limb positive, negative and net power across grades. For both walking and running, changes in grade caused a redistribution of joint mechanical power generation and absorption. From level to incline walking, the ankle's contribution to limb positive power decreased from 44% on the level to 28% at 8.53° uphill grade (p < 0.0001) while the hip's contribution increased from 27% to 52% (p < 0.0001). In running, regardless of the surface gradient, the ankle was consistently the dominant source of lower-limb positive mechanical power (47-55%). In the context of our results, we outline three distinct use-modes that could be emphasized in future lower-limb exoskeleton designs 1) Energy injection: adding positive work into the gait cycle, 2) Energy extraction: removing negative work from the gait cycle, and 3) Energy transfer: extracting energy in one gait phase and then injecting it in another phase (i.e., regenerative braking).

The metabolic power required to support body weight and accelerate body mass changes during walking on uphill and downhill slopes

The metabolic cost of walking is due to muscle force generated to support body weight (BW), external work performed to redirect and accelerate the center of mass (CoM), and internal work performed to swing the limbs and maintain balance. We hypothesized that BW support would incur a greater and lower percentage of Net Metabolic Power (NMP) for uphill and downhill slopes, respectively, compared to level-ground walking. Additionally, we hypothesized that mass redirection would incur a greater and lower percentage of NMP for uphill and downhill slopes, respectively compared to level-ground walking. 10 subjects walked at 1.25 m/s on 0°, ±3°, and ±6° slopes with reduced/added weight and added mass while we measured metabolic rates. We calculated NMP per Newton of reduced BW at each slope and found that BW support required 58% and 64% of the NMP to walk at +3° and +6°, respectively, both greater than the 15% required for level-ground walking (p < 0.025). We calculated NMP per kg of added mass at each slope and found that mass redirection required 19% and 23% of the NMP to walk at +3° and +6°, respectively, both lower than the 35% required for level-ground walking (p < 0.025). We found no significant differences in the percentage of NMP for BW support or mass redirection during downhill compared to level ground walking (p > 0.05). Our findings elucidate that the percentage of NMP attributed to BW support and mass redirection is different for sloped compared to level-ground walking. These results inform biomimetic assistive device designs aimed at reducing metabolic cost.

An Overview on Principles for Energy Efficient Robot Locomotion

Despite enhancements in the development of robotic systems, the energy economy of today's robots lags far behind that of biological systems. This is in particular critical for untethered legged robot locomotion. To elucidate the current stage of energy efficiency in legged robotic systems, this paper provides an overview on recent advancements in development of such platforms. The covered different perspectives include actuation, leg structure, control and locomotion principles. We review various robotic actuators exploiting compliance in series and in parallel with the drive-train to permit energy recycling during locomotion. We discuss the importance of limb segmentation under efficiency aspects and with respect to design, dynamics analysis and control of legged robots. This paper also reviews a number of control approaches allowing for energy efficient locomotion of robots by exploiting the natural dynamics of the system, and by utilizing optimal control approaches targeting locomotion expenditure. To this end, a set of locomotion principles elaborating on models for energetics, dynamics, and of the systems is studied.

A comparison of stability metrics based on inverted pendulum models for assessment of ramp walking

Maintaining balance on ramps is important for mobility. However, balance is commonly assessed using inverted pendulum-based metrics (e.g., margin of stability), which may not be appropriate for assessment of human walking on non-level surfaces. To investigate this, we analyzed stability on ramps using four different inverted pendulum models: extrapolated center of mass (XCOM), foot placement estimate (FPE), foot placement estimate neglecting angular momentum (FPE_NoH), and capture point (CAP). We analyzed experimental data from 10 able-bodied individuals walking on a ramp at 0°, ±5°, and ±10°. Contrary to our hypothesis that the magnitude of differences between metrics would be greatest at ±10°, we observed the greatest magnitude of differences between metrics at 0°. In general, the stability metrics were bounded by FPE and CAP at each slope, consistent with prior studies of level walking. Our results also suggest that clinical providers and researchers should be aware that assessments that neglect angular momentum (e.g., margin of stability, XCOM) may underestimate stability in the sagittal-plane in comparison to analyses which incorporate angular momentum (e.g., FPE). Except for FPE_NoH-CAP (r = 0.82), differences between metrics were only moderately correlated (|r|≤0.65) with violations of leg length assumptions in the underlying inverted pendulum models. The differences in FPE_NoH relative to FPE and CAP were strongly correlated with body center of mass vertical velocity (max |r| = 0.92), suggesting that model representations of center of mass motion influence stability metrics. However, there was not a clear overall relationship between model inputs and differences in stability metrics. Future sensitivity analyses may provide additional insight into model characteristics that influence stability metrics.

Use of a powered ankle-foot prosthesis reduces the metabolic cost of uphill walking and improves leg work symmetry in people with transtibial amputations

People with transtibial amputations (TTAs) who use a powered ankle-foot prosthesis have equivalent metabolic costs and step-to-step transition work for level-ground walking over a range of speeds compared to non-amputees. The effects of using a powered compared to passive-elastic prosthesis for sloped walking are unknown. We sought to understand how the use of passive-elastic compared to powered ankle-foot prostheses affect metabolic cost and step-to-step transition work during sloped walking. Ten people (six M, four F) with TTAs walked 1.25 m s-1 at 0°, ±3°, ±6° and ±9° using their own passive-elastic prosthesis and the BiOM powered ankle-foot prosthesis, while we measured metabolic rates, kinematics and kinetics. We calculated net metabolic power, individual leg step-to-step transition work and individual leg net work symmetry. The net metabolic power was 5% lower during walking on +3° and +6° uphill slopes when subjects used the BiOM compared to their passive-elastic prosthesis (p < 0.05). The use of the BiOM compared to a passive-elastic prosthesis did not affect individual leg step-to-step transition work (p > 0.05), but did improve individual leg net work symmetry on +6° and +9° uphill slopes (p < 0.01). People with TTAs who use a powered ankle-foot prosthesis have the potential to reduce metabolic costs and increase symmetry during walking on uphill slopes.

The Functional Roles of Muscles, Passive Prostheses, and Powered Prostheses During Sloped Walking in People With a Transtibial Amputation

Sloped walking is challenging for individuals with transtibial amputation (TTA) due to the functional loss of the ankle plantarflexors. Prostheses that actively generate ankle power may help to restore this lost function. The purpose of this study was to use musculoskeletal modeling and simulation to quantify the mechanical power delivered to body segments by passive and powered prostheses and the remaining muscles in the amputated and intact legs during sloped walking. We generated walking simulations from experimental kinematic and kinetic data on slopes of 0, ±3 deg and ±6 deg in eight people with a TTA using powered and passive prostheses and eight nonamputees. Consistent with our hypothesis, the amputated leg hamstrings generated more power to both legs on uphill slopes in comparison with nonamputees, which may have implications for fatigue or overuse injuries. The amputated leg knee extensors delivered less power to the trunk on downhill slopes (effect size (ES) ≥ 1.35, p ≤ 0.02), which may be due to muscle weakness or socket instability. The power delivered to the trunk from the powered and passive prostheses was not significantly different (p > 0.05), However, using the powered prosthesis on uphill slopes reduced the contributions from the amputated leg hamstrings in all segments (ES ≥ 0.46, p ≤ 0.003), suggesting that added ankle power reduces the need for the hamstrings to compensate for lost ankle muscle function. Neither prosthesis replaced gastrocnemius function to absorb power from the trunk and deliver it to the leg on all slopes.

Pendular energy transduction within the step during human walking on slopes at different speeds

When ascending (descending) a slope, positive (negative) work must be performed to overcome changes in gravitational potential energy at the center of body mass (COM). This modifies the pendulum-like behavior of walking. The aim of this study is to analyze how energy exchange and mechanical work done vary within a step across slopes and speeds. Ten subjects walked on an instrumented treadmill at different slopes (from -9° to 9°), and speeds (between 0.56 and 2.22 m s^-1). From the ground reaction forces, we evaluated energy of the COM, recovery (i.e. the potential-kinetic energy transduction) and pendular energy savings (i.e. the theoretical reduction in work due to this recovered energy) throughout the step. When walking uphill as compared to level, pendular energy savings increase during the first part of stance (when the COM is lifted) and decreases during the second part. Conversely in downhill walking, pendular energy savings decrease during the first part of stance and increase during the second part (when the COM is lowered). In uphill and downhill walking, the main phase of external work occurs around double support. Uphill, the positive work phase is extended during the beginning of single support to raise the body. Downhill, the negative work phase starts before double support, slowing the downward velocity of the body. Changes of the pendulum-like behavior as a function of slope can be illustrated by tilting the 'classical compass model' backwards (uphill) or forwards (downhill).

The functional roles of muscles during sloped walking

Sloped walking is biomechanically different from level-ground walking, as evidenced by changes in joint kinematics and kinetics. However, the changes in muscle functional roles underlying these altered movement patterns have not been established. In this study, we developed a total of 273 muscle-actuated simulations to assess muscle functional roles, quantified by induced body center-of-mass accelerations and trunk and leg power, during walking on slopes of 0°, ±3°, ±6°, and ±9° at 1.25m/s. The soleus and gastrocnemius both provided greater forward acceleration of the body parallel to the slope at +9° compared to level ground (+126% and +66%, respectively). However, while the power delivered to the trunk by the soleus varied with slope, the magnitude of net power delivered to the trunk and ipsilateral leg by the biarticular gastrocnemius was similar across all slopes. At +9°, the hip extensors absorbed more power from the trunk (230% hamstrings, 140% gluteus maximus) and generated more power to both legs (200% hamstrings, 160% gluteus maximus) compared to level ground. At -9°, the knee extensors (rectus femoris and vasti) accelerated the body upward perpendicular to the slope at least 50% more and backward parallel to the slope twice as much as on level ground. In addition, the knee extensors absorbed greater amounts of power from the ipsilateral leg on greater declines to control descent. Future studies can use these results to develop targeted rehabilitation programs and assistive devices aimed at restoring sloped walking ability in impaired populations.