Development and Preliminary Evaluation of a Bimodal Foot Prosthesis for Walking and Running

People often alternate between bouts of walking and running, for instance, when adults participate in recreational activities. Transitioning between activities can be challenging for prosthesis users because existing prosthetic feet are not well-suited for both tasks. Meanwhile, switching between prostheses for different tasks is often impractical. Collectively, these challenges can present barriers to physical activity participation for people with limb loss, which can negatively impact social or physical health. This work describes the development and evaluation of a passive bimodal prosthetic foot prototype with different configurations and stiffnesses for walking and running. Users rated the bimodal prosthesis higher for standing and walking compared to a running prosthesis (+2.3 for both tasks on a seven-point Likert scale). Users rated the bimodal prosthesis higher for running compared to a walking prosthesis (+1.7 and +0.5 for 2.0 and 2.5 m/s running, respectively). Changing from walking to running mode increased the device's stiffness by 23-84%, depending on the user's preference. Users could switch between bimodal prosthesis walking and running modes quickly (21.3 ± 12.0 s). Overall, the preliminary results were encouraging in terms of user satisfaction, stiffness change between modes, and mode-switching speed. These findings motivate future exploration of this bimodal prosthesis concept.

Changes in Dynamic Mean Ankle Moment Arm in Unimpaired Walking Across Speeds, Ramps, and Stairs

Understanding the natural biomechanics of walking at different speeds and activities is crucial to develop effective assistive devices for persons with lower-limb impairments. While continuous measures such as joint angle and moment are well-suited for biomimetic control of robotic systems, whole-stride summary metrics are useful for describing changes across behaviors and for designing and controlling passive and semi-active devices. Dynamic mean ankle moment arm (DMAMA) is a whole-stride measure representing the moment arm of the ground reaction impulse about the ankle joint-effectively, how "forefoot-dominated" or "hindfoot-dominated" a movement is. DMAMA was developed as a target and performance metric for semi-active devices that adjust once per stride. However, for implementation in this application, DMAMA must be characterized across various activities in unimpaired individuals. In our study, unimpaired participants walked at "slow," "normal," and "fast" self-selected speeds on level ground and at a normal self-selected speed while ascending and descending stairs and a 5-degree incline ramp. DMAMA measured from these activities displayed a borderline-significant negative sensitivity to walking speed, a significant positive sensitivity to ground incline, and a significant decrease when ascending stairs compared to descending. The data suggested a nonlinear relationship between DMAMA and walking speed; half of the participants had the highest average DMAMA at their "normal" speed. Our findings suggest that DMAMA varies substantially across activities, and thus, matching DMAMA could be a valuable metric to consider when designing biomimetic assistive lower-limb devices.

Variable-stiffness prosthesis improves biomechanics of walking across speeds compared to a passive device

Ankle push-off power plays an important role in healthy walking, contributing to center-of-mass acceleration, swing leg dynamics, and accounting for 45% of total leg power. The majority of existing passive energy storage and return prostheses for people with below-knee (transtibial) amputation are stiffer than the biological ankle, particularly at slower walking speeds. Additionally, passive devices provide insufficient levels of energy return and push-off power, negatively impacting biomechanics of gait. Here, we present a clinical study evaluating the kinematics and kinetics of walking with a microprocessor-controlled, variable-stiffness ankle-foot prosthesis (945 g) compared to a standard low-mass passive prosthesis (Ottobock Taleo, 463 g) with 7 study participants having unilateral transtibial amputation. By modulating prosthesis stiffness under computer control across walking speeds, we demonstrate that there exists a stiffness that increases prosthetic-side energy return, peak power, and center-of-mass push-off work, and decreases contralateral limb peak ground reaction force compared to the standard passive prosthesis across all evaluated walking speeds. We demonstrate a significant increase in center-of-mass push-off work of 26.1%, 26.2%, 29.6% and 29.9% at 0.75 m/s, 1.0 m/s, 1.25 m/s, and 1.5 m/s, respectively, and a significant decrease in contralateral limb ground reaction force of 3.1%, 3.9%, and 3.2% at 1.0 m/s, 1.25 m/s, and 1.5 m/s, respectively. This study demonstrates the potential for a quasi-passive microprocessor-controlled variable-stiffness prosthesis to increase push-off power and energy return during gait at a range of walking speeds compared to a passive device of a fixed stiffness.

AdjuSST: An Adjustable Surface Stiffness Treadmill

Humans have the remarkable ability to manage foot-ground interaction seamlessly across terrain changes despite the high dynamic complexity of the task. Understanding how adaptation in the neuromotor system enables this level of robustness in the face of changing interaction dynamics is critical for developing more effective gait retraining interventions. We developed an adjustable surface stiffness treadmill (AdjuSST) to trigger these adaptation mechanisms and enable studies to better understand human adaptation to changing foot-ground dynamics. The AdjuSST system makes use of fundamental beam-bending principles; it controls surface stiffness by controlling the effective length of a cantilever beam. The beam acts as a spring suspension for the transverse endpoint load applied through the treadmill. The system is capable of enforcing a stiffness range of 15-300kN/m within 340 ms, deflecting linearly downwards up to 10 cm, and comfortably accommodating two full steps of travel along the belt. AdjuSST offers significant enhancements in effective walking surface length compared to similar systems, while also maintaining a useful stiffness range and responsive spring suspension. These improvements enhance our ability to study locomotor control and adaptation to changes in surface stiffness, as well as provide new avenues for gait rehabilitation.

The contribution of lower-limb joint quasi-stiffness to theoretical leg stiffness during level, uphill and downhill running at different speeds

Humans change joint quasi-stiffness (k joint) and leg stiffness (kleg) when running at different speeds on level ground and during uphill and downhill running. These mechanical properties can inform device designs for running such as footwear, exoskeletons and prostheses. We measured kinetics and kinematics from 17 runners (10 M; 7 F) at three speeds on 0°, ±2°, ±4° and ±6° slopes. We calculated ankle and knee k joint, the quotient of change in joint moment and angular displacement, and theoretical leg stiffness (klegT) based on the joint external moment arms and k joint. Runners increased k ankle at faster speeds (p < 0.01). Runners increased and decreased the ankle and knee contributions to klegT, respectively, by 2.89% per 1° steeper uphill slope (p < 0.01) during the first half of stance. Runners decreased and increased ankle and knee joint contributions to klegT, respectively, by 3.68% during the first half and 0.86% during the second half of stance per 1° steeper downhill slope (p < 0.01). Thus, biomimetic devices require stiffer k ankle for faster speeds, and greater ankle contributions and greater knee contributions to klegT during the first half of stance for steeper uphill and downhill slopes, respectively.

Improving Walking Energy Efficiency in Transtibial Amputees Through the Integration of a Low-Power Actuator in an ESAR Foot

Reducing energy consumption during walking is a critical goal for transtibial amputees. The study presents the evaluation of a semi-active prosthesis with five transtibial amputees. The prosthesis has a low-power actuator integrated in parallel into an energy-storing-and-releasing foot. The actuator is controlled to compress the foot during the stance phase, supplementing the natural compression due to the user's dynamic interaction with the ground, particularly during the ankle dorsiflexion phase, and to release the energy stored in the foot during the push-off phase, to enhance propulsion. The control strategy is adaptive to the user's gait patterns and speed. The clinical protocol to evaluate the system included treadmill and overground walking tasks. The results showed that walking with the semi-active prosthesis reduced the Physiological Cost Index of transtibial amputees by up to 16% compared to walking using the subjects' proprietary prosthesis. No significant alterations were observed in the spatiotemporal gait parameters of the participants, indicating the module's compatibility with users' natural walking patterns. These findings highlight the potential of the mechatronic actuator in effectively reducing energy expenditure during walking for transtibial amputees. The proposed prosthesis may bring a positive impact on the quality of life, mobility, and functional performance of individuals with transtibial amputation.

Perceptions and biomechanical effects of varying prosthetic ankle stiffness during uphill walking: A case series

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.

Biomechanical effects of an articulating prosthetic toe joint during stair navigation for individuals with unilateral, below-knee limb loss

Stair navigation is an essential and demanding form of locomotion. During stair ascent and descent, persons with lower limb loss exhibit gait characteristics which may increase their risk of falls and joint degeneration of the intact limb. To reduce deviations from typically-able-bodied gait and overloading of the intact limb for this population, one potential intervention involves modifying passive prosthetic feet by incorporating a flexible toe joint that simulates the biological metatarsophalangeal joint. In this study, we aimed to assess the user preferences and biomechanical effects of a flexible prosthetic toe joint during stair ascent and descent for persons with unilateral lower-limb loss. Nine participants with unilateral lower-limb loss were recruited (Male; Medicare Functional Classification Level: eight K4, one K3; age: 41 ± 11 years; mass: 95 ± 13 kg; height: 1.84 ± 0.05 m; mean ± SD). No significant changes in lower-limb joint mechanics were identified. Five of nine participants preferred the unmodified prosthesis with a standard carbon fiber keel for both stair ascent and descent. Varied user preferences and inconsistent changes in lower-limb joint parameters between participants highlight the importance of subject-specific analyses and individualized device prescription.

Characterization of the ankle dynamic joint stiffness as a function of gait speed for overground and treadmill walking

The ankle dynamic joint stiffness (DJS), defined as the slope of the joint angle-moment plot, measures the resistance of the ankle joint to movement when the foot is in contact with the ground. DJS helps to stabilize the ankle joint, and its characterization helps to identify gait pathology and assist foot prosthesis design. This study analyzes the available gait dynamics data to obtain ankle DJS parameters for population groups according to age, gender, and gait speed for overground and treadmill walking. This study classified the groups into five walking speeds normalized using the Froude number. Herein, 12 ankle DJS parameters were determined. These include four linear segments: controlled plantar flexion (CP), early response phase (ERP), large response phase (LRP), and descending phase (DP), their corresponding turning points, the net mechanical work, the absorbed work, and the loop direction. Ankle dynamics data for 92 individuals was collected from two gait data repositories. The analysis reveals a notable disparity in stiffness values between overground and treadmill gait. Specifically, the CP stiffness is significantly higher for overground gait. In contrast, the DP stiffness displays an opposing pattern, with higher values observed during treadmill walking. A negative stiffness for LRP was found at fast speeds for all groups. The sorted data, analysis tools, and findings of this study are meant to help practitioners design prosthetic and rehabilitation devices based on age, gender, and walking environment at different gait speeds.

A Scientometric Analysis and Visualization of Prosthetic Foot Research Work: 2000 to 2022

This study aims to highlight recent research work on topics around prosthetic feet through a scientometric analysis and historical review. The most cited publications from the Clarivate Analytics Web of Science Core Collection database were identified and analyzed from 1 January 2000 to 31 October 2022. Original articles, reviews with full manuscripts, conference proceedings, early access documents, and meeting abstracts were included. A scientometric visualization analysis of the bibliometric information related to the publications, including the countries, institutions, journals, references, and keywords, was conducted. A total of 1827 publications met the search criteria in this study. The related publications grouped by year show an overall trend of increase during the two decades from 2000 to 2022. The United States is ranked first in terms of overall influence in this field (n = 774). The Northwestern University has published the most papers on prosthetic feet (n = 84). Prosthetics and Orthotics International has published the largest number of studies on prosthetic feet (n = 151). During recent years, a number of studies with citation bursts and burst keywords (e.g., diabetes, gait, pain, and sensor) have provided clues on the hotspots of prosthetic feet and prosthetic foot trends. The findings of this study are based on a comprehensive analysis of the literature and highlight the research topics on prosthetic feet that have been primarily explored. The data provide guidance to clinicians and researchers to further studies in this field.

Design of a Quasi-Passive Ankle-Foot Orthosis with Customizable, Variable Stiffness

Most commercial ankle-foot orthoses (AFOs) are passive structures that cannot modulate stiffness to assist with a diverse range of activities, such as stairs and ramps. It is sometimes possible to change the stiffness of passive AFOs through reassembly or benchtop adjustment, but they cannot change stiffness during use. Passive AFOs are also limited in their ankle mechanics and cannot replicate a biomimetic, nonlinear torque-angle relationship. Many research labs have developed ankle exoskeletons that show promise as viable alternatives to passive AFOs, but they face challenges with reliability, mass, and cost. Consequently, commercial translation has largely failed to date. Here we introduce the Variable Stiffness Orthosis (VSO), a quasi-passive variable stiffness ankle-foot orthosis that strikes a balance between powered and passive systems, in terms of mass, complexity, and onboard intelligence. The VSO has customizable torque-angle relationships via a cam transmission, and can make step-to-step stiffness adjustments via motorized reconfiguration of a spring support along a lead-screw. In this work, we introduce two versions: a nominal and a stiff prototype, which differ primarily in their mass and available stiffness levels. The available torque-angle relationships are measured on a custom dynamometer and closely match model predictions. The experimental results showed that the prototypes are capable of producing ankle stiffness coefficients between 9 - 330 Nm/rad.

On the Usability of Polymer-Based Artificial Tendons for Elastic Energy Storage in Active Ankle Prostheses

In the recent past, the development of lower-limb prostheses has taken a new turn with the emergence of active systems. However, their intrinsic wearable nature induces strict requirements regarding weight and encumbrance. In order to reduce the load - and thus the bulkiness - of their active part, several prototypes leverage the concept of compliant actuation, consisting in including an elastic element in parallel and/or in series with the actuator. In this paper, we explore the usability of polymer compliant ropes placed in parallel with the actuator of an ankle prosthesis. Ropes are intrinsically light and compact, and thus offer several advantages as compared to more traditional coil or leaf springs. Polymer materials were selected for their high energy density and yield strength. We conducted a set of experimental tests with several ropes, pretension levels, and periodic loading profiles. Results show that polymer-based ropes have a high potential for ankle assistance devices, since they can store the required energy in a low volume. However, further research should be conducted to improve their efficiency, since we estimated that only about 50% of the stored energy can be released, with few variations as a function of the rope preconditioning and loading profile.

Comparison of Two Design Principles of Unpowered Ankle-Foot Orthoses for Supporting Push-Off: A Case Study

Ankle propulsion is essential for efficient human walking. In recent years, several working principles have been investigated and applied to ankle-foot orthoses (AFOs) to enhance the work of the plantarflexor muscles and achieve proper propulsion during gait. Comparing the performance and effectiveness of different designs is difficult because researchers do not have a standardized set of criteria and procedures to follow. This leads to a wide range of tests being conducted, with variations in important factors such as walking speed and assistance provided, which greatly affect users' kinematics and kinetics. In this work, we investigate the possibilities and potential benefits of two of the most important design principles for supporting ankle propulsion with unpowered AFOs. To this end, we present and evaluate two AFO prototypes with springs parallel to the Achilles tendon based on: (i) a linear compression spring, and (ii) a customized leaf spring-cam transmission with a non-linear ankle torque-angle curve. The effects of both AFOs are reported for a case study with one healthy participant using both prototypes at two walking speeds under the same experimental conditions. Large reductions in muscular activity were found when the user received assistance, and ankle kinematics were influenced by the different assistance approaches. This case study was intended as a first step to provide insights on how two promising principles can passively support push-off during gait.

Design trends in actuated lower-limb prosthetic systems: a narrative review

INTRODUCTION

Actuated lower limb prostheses, including powered (active) and semi-active (quasi-passive) joints, are endowed with controllable power and/or impedance, which can be advantageous to limb impairment individuals by improving locomotion mechanics and reducing the overall metabolic cost of ambulation. However, an increasing number of commercial and research-focused options have made navigating this field a daunting task for users, researchers, clinicians, and professionals.

AREAS COVERED

The present paper provides an overview of the latest trends and developments in the field of actuated lower-limb prostheses and corresponding technologies. Following a gentle summary of essential gait features, we introduce and compare various actuated prosthetic solutions in academia and the market designed to provide assistance at different levels of impairments. Correspondingly, we offer insights into the latest developments of sockets and suspension systems, before finally discussing the established and emerging trends in surgical approaches aimed at improving prosthetic experience through enhanced physical and neural interfaces.

EXPERT OPINION

The ongoing challenges and future research opportunities in the field are summarized for exploring potential avenues for development of next generation of actuated lower limb prostheses. In our opinions, a closer multidisciplinary integration can be found in the field of actuated lower-limb prostheses in the future.

A low-power ankle-foot prosthesis for push-off enhancement

Passive ankle-foot prostheses are light-weighted and reliable, but they cannot generate net positive power, which is essential in restoring the natural gait pattern of amputees. Recent robotic prostheses addressed the problem by actively controlling the storage and release of energy generated during the stance phase through the mechanical deformation of elastic elements housed in the device. This study proposes an innovative low-power active prosthetic module that fits on off-the-shelf passive ankle-foot energy-storage-and-release (ESAR) prostheses. The module is placed parallel to the ESAR foot, actively augmenting the energy stored in the foot and controlling the energy return for an enhanced push-off. The parallel elastic actuation takes advantage of the amputee's natural loading action on the foot's elastic structure, retaining its deformation. The actuation unit is designed to additionally deform the foot and command the return of the total stored energy. The control strategy of the prosthesis adapts to changes in the user's cadence and loading conditions to return the energy at a desired stride phase. An early verification on two transtibial amputees during treadmill walking showed that the proposed mechanism could increase the subjects' dorsiflexion peak of 15.2% and 41.6% for subjects 1 and 2, respectively, and the cadence of about 2%. Moreover, an increase of 26% and 45% was observed in the energy return for subjects 1 and 2, respectively.

Revolutionizing Prosthetic Design with Auxetic Metamaterials and Structures: A Review of Mechanical Properties and Limitations

Prosthetics have come a long way since their inception, and recent advancements in materials science have enabled the development of prosthetic devices with improved functionality and comfort. One promising area of research is the use of auxetic metamaterials in prosthetics. Auxetic materials have a negative Poisson's ratio, which means that they expand laterally when stretched, unlike conventional materials, which contract laterally. This unique property allows for the creation of prosthetic devices that can better conform to the contours of the human body and provide a more natural feel. In this review article, we provide an overview of the current state of the art in the development of prosthetics using auxetic metamaterials. We discuss the mechanical properties of these materials, including their negative Poisson's ratio and other properties that make them suitable for use in prosthetic devices. We also explore the limitations that currently exist in implementing these materials in prosthetic devices, including challenges in manufacturing and cost. Despite these challenges, the future prospects for the development of prosthetic devices using auxetic metamaterials are promising. Continued research and development in this field could lead to the creation of more comfortable, functional, and natural-feeling prosthetic devices. Overall, the use of auxetic metamaterials in prosthetics represents a promising area of research with the potential to improve the lives of millions of people around the world who rely on prosthetic devices.

Structural optimisation for controlled deflections of additively manufactured single material beams

Closely controlling the mechanical behaviour and characterization of the deflection of a beam structure is a well-known and widely studied engineering problem. The progress in additive manufacturing methods and the possibilities to closely control the material property variations with the controlled placement of materials further widen the opportunities to achieve given beam deflection criteria. The multi-material additive manufacturing solutions suffer from the lack of real engineering material options, and the quality and performance of the printed parts are usually unsuitable for producing functional parts. A novel cellular structured solution is proposed here, which utilises optimisation of geometries of individual cells of a single material structured beam to obtain deflection profiles closely matched with preset conditions under different loading conditions. The cellular geometry of the structured beam is continually altered for searching and converging on the optimal structure of the cells by the covariance matrix adaptation evolution strategy algorithm in an iterative manner. The optimised beam structures could also be physically produced with single material additive manufacturing methods and the experimental and numerical beam deflection responses correlated closely.

Exoskeletal solutions to enable mobility with a lower leg fracture in austere environments

The treatment and evacuation of people with lower limb fractures in austere environments presents unique challenges that assistive exoskeletal devices could address. In these dangerous situations, independent mobility for the injured can preserve their vital capabilities so that they can safely evacuate and minimize the need for additional personnel to help. This expert view article discusses how different exoskeleton archetypes could provide independent mobility while satisfying the requisite needs for portability, maintainability, durability, and adaptability to be available and useful within austere environments. The authors also discuss areas of development that would enable exoskeletons to operate more effectively in these scenarios as well as preserve the health of the injured limb so that definitive treatment after evacuation will produce better outcomes.

Sensitivity of lower-limb joint mechanics to prosthetic forefoot stiffness with a variable stiffness foot in level-ground walking

This paper presents the effectsof the Variable Stiffness Foot (VSF) on lower-limb joint mechanics in level-ground walking. Persons with transtibial amputations use lower-limb prostheses to restore level-ground walking, and foot stiffness and geometry have been shown to be the main factors for evaluating foot prostheses. Previous studies have validated the semi-active and stiffness modulation capabilities of the VSF. The core aim of this study is to investigate the mechanical effects of adjusting stiffness on knee and ankle mechanics for prosthetic users wearing the VSF. For this study, seven human participants walked with three different stiffnesses (compliant, medium, stiff) of the VSF across two force plates in a motion capture lab. Linear mixed models were utilized to estimate the significance and coefficients of determinations for the regression of stiffness on several biomechanical metrics. A stiffer VSF led to decreased ankle dorsiflexion angle (p < 0.0001, r2 = 0.90), increased ankle plantarflexor moment (p = 0.016, r2 = 0.40), increased knee extension (p = 0.021, r2 = 0.37), increased knee flexor moment (p = 0.0007, r2 = 0.63), and decreased magnitudes of prosthetic energy storage (p < 0.0001, r2 = 0.90), energy return (p = 0.0003, r2 = 0.67), and power (p < 0.0001, r2 = 0.74). These results imply lower ankle, knee, and hip moments, and more ankle angle range of motion using a less stiff VSF, which may be advantageous to persons walking with lower-limb prostheses. Responsive modulation of the VSF stiffness, according to these findings, could help overcome gait deviations associated with different slopes, terrain characteristics, or footwear.

A lightweight robotic leg prosthesis replicating the biomechanics of the knee, ankle, and toe joint

Robotic leg prostheses promise to improve the mobility and quality of life of millions of individuals with lower-limb amputations by imitating the biomechanics of the missing biological leg. Unfortunately, existing powered prostheses are much heavier and bigger and have shorter battery life than conventional passive prostheses, severely limiting their clinical viability and utility in the daily life of amputees. Here, we present a robotic leg prosthesis that replicates the key biomechanical functions of the biological knee, ankle, and toe in the sagittal plane while matching the weight, size, and battery life of conventional microprocessor-controlled prostheses. The powered knee joint uses a unique torque-sensitive mechanism combining the benefits of elastic actuators with that of variable transmissions. A single actuator powers the ankle and toe joints through a compliant, underactuated mechanism. Because the biological toe dissipates energy while the biological ankle injects energy into the gait cycle, this underactuated system regenerates substantial mechanical energy and replicates the key biomechanical functions of the ankle/foot complex during walking. A compact prosthesis frame encloses all mechanical and electrical components for increased robustness and efficiency. Preclinical tests with three individuals with above-knee amputation show that the proposed robotic leg prosthesis allows for common ambulation activities with close to normative kinematics and kinetics. Using an optional passive mode, users can walk on level ground indefinitely without charging the battery, which has not been shown with any other powered or microprocessor-controlled prostheses. A prosthesis with these characteristics has the potential to improve real-world mobility in individuals with above-knee amputation.

Metatarsophalangeal Joint Dynamic Stiffness During Toe Rocker Changes With Walking Speed

Dynamic joint stiffness (or simply "stiffness") is a customization criteria used to tune mechanical properties of orthotic and prosthetic devices. This study examines metatarsophalangeal (MTP) joint stiffness during the toe-rocker phase of barefoot walking and establishes baseline characteristics of MTP joint stiffness. Ten healthy individuals walked at 4 speeds (0.4, 0.6, 0.8, and 1.0 statures·s-1) over level ground. MTP sagittal plane joint angles and moments were calculated during the toe-rocker phase of stance. Least-squares linear regressions were conducted on the MTP moment versus angle curve to determine joint stiffness during early toe rocker and late toe rocker. Multilevel linear models were used to test for statistically significant differences between conditions. Early toe rocker stiffness was positive, while late toe rocker was negative. Both early toe rocker and late toe rocker stiffness increased in magnitude significantly with speed. This study establishes baseline characteristics of MTP joint stiffness in healthy walking, which previously had not been examined through a range of controlled walking speeds. This information can be used in the future as design criteria for orthotic and prosthetic ankle and ankle-foot devices that can imitate, support, and facilitate natural human foot motion during walking better than existing devices.

Design optimization of powered ankle prosthesis to reduce peak power requirement

The aim of the prosthetic devices is to replicate the able-bodied angle-torque profile of a healthy human during locomotion. A lightweight and energy-efficient ankle joint is able to lower the actuator peak power and/or energy consumption per gait cycle, while adequately fulfilling the profile matching constraints. This study presents the design optimization of the prosthetic ankle joint containing an elastic element and actuator coupled with a rigid triangular part. The dimensions of the ankle joint triangular part were optimized to minimize actuator peak power and maximize spring energy within its elastic limits. As a result of series simulation tests, at 1.1 and 1.6 m/s walking speeds, the simulation of dorsi/plantar flexion shows up to 78.8% and 66.98% reduction in motor peak power compared to a direct drive system, respectively. Low power ankle-prosthetic device that closely matches the angle-torque profile of a healthy human's ankle, is one of the key parameters for the cost-effectiveness of lower limb prostheses.

Comparison of Existing Methods for Characterizing Bi-Linear Natural Ankle Quasi-Stiffness

Natural ankle quasi-stiffness (NAS) is a mechanical property of the ankle joint during motion. NAS has been historically calculated as the average slope (linear regression) of the net ankle moment vs. ankle angle during discrete phases of stance. However, recent work has shown that NAS is nonlinear during stance. Specifically, during the loading phase (~10-60% of stance), plantarflexion moment increases at an accelerating rate compared to dorsiflexion angle. Updated models have been developed to better capture this inherent nonlinearity. One type of model is called bi-linear NAS (BL-NAS) divides the loading phase of stance into two sub-phases, called early loading (EL) and late loading (LL) NAS. Two papers, written by Crenna & Frigo in 2011 and Shamaei et al. in 2013, outline different BL-NAS models. Both models fit measured data better (lower RMSE) than standard single linear NAS (SL-NAS) models, but have not been widely adopted, possibly because of methodological discrepancies and lack of applicability to physical devices at the time. This paper compares these existing BL-NAS models and translate those findings to possible orthotic device designs. Results showed that both BL-NAS models had lower RMSE than SL-NAS, EL-NAS was not significantly different across walking speeds, and LL-NAS increased significantly at faster walking speeds. These improved NAS models better approximate natural human movement than commonly used SL-NAS models, and provide a basis to design ankle-foot devices with multiple stiffness properties to emulate and facilitate natural human motion.

The Functionality Verification through Pilot Human Subject Testing of MyFlex-δ: An ESR Foot Prosthesis with Spherical Ankle Joint

Most biomechanical research has focused on level-ground walking giving less attention to other conditions. As a result, most lower limb prosthesis studies have focused on sagittal plane movements. In this paper, an ESR foot is presented, of which five different stiffnesses were optimized for as many weight categories of users. It is characterized by a spherical ankle joint, with which, combined with the elastic elements, the authors wanted to create a prosthesis that gives the desired stiffness in the sagittal plane but at the same time, gives flexibility in the other planes to allow the adaptation of the foot prosthesis to the ground conditions. The ESR foot was preliminarily tested by participants with transfemoral amputation. After a brief familiarization with the device, each participant was asked to wear markers and to walk on a sensorized treadmill to measure their kinematics and kinetics. Then, each participant was asked to leave feedback via an evaluation questionnaire. The measurements and feedback allowed us to evaluate the performance of the prosthesis quantitatively and qualitatively. Although there were no significant improvements on the symmetry of the gait, due also to very limited familiarization time, the participants perceived an improvement brought by the spherical ankle joint.

Validation of Methods for Estimation of Knee Joint Mechanical Impedance During Locomotion Using a Torque-Controllable Knee Exoskeleton

The mechanical impedance of the joints of the leg governs the body's response to external disturbances, and its regulation is essential for the completion of tasks of daily life. However, it is still unclear how this quantity is regulated at the knee during dynamic tasks. In this work, we introduce a method to estimate the mechanical impedance of spring-mass systems using a torque-controllable exoskeleton with the intention of extending these methods to characterize the mechanical impedance of the human knee during locomotion. We characterize system bandwidth and intrinsic impedance and present a perturbation-based methodology to identify the mechanical impedance of known spring-mass systems. Our approach was able to obtain accurate estimates of stiffness and inertia, with errors under 3% and ∼13-16%, respectively. This work provides a qualitative and quantitative foundation that will enable accurate estimates of knee joint impedance during locomotion in future works.

Challenges and solutions for application and wider adoption of wearable robots

The science and technology of wearable robots are steadily advancing, and the use of such robots in our everyday life appears to be within reach. Nevertheless, widespread adoption of wearable robots should not be taken for granted, especially since many recent attempts to bring them to real-life applications resulted in mixed outcomes. The aim of this article is to address the current challenges that are limiting the application and wider adoption of wearable robots that are typically worn over the human body. We categorized the challenges into mechanical layout, actuation, sensing, body interface, control, human-robot interfacing and coadaptation, and benchmarking. For each category, we discuss specific challenges and the rationale for why solving them is important, followed by an overview of relevant recent works. We conclude with an opinion that summarizes possible solutions that could contribute to the wider adoption of wearable robots.

Design of an Underactuated Powered Ankle and Toe Prosthesis

Powered ankle/foot prostheses aim to replicate the biomechanical function of the missing biological limb. Biomechanical analysis shows that while the ankle injects positive energy into the gait cycle, the toe joint dissipates energy. Yet virtually all powered ankle/foot prostheses use custom ankle actuators in combination with carbon fiber foot springs to imitate the function of the missing ankle/foot complex. Here we introduce a powered ankle and toe prosthesis with an underactuated mechanism. The underactuated mechanism connects the toe and ankle joints, providing biomechanically accurate torque and enabling mechanical energy recovery during gait. The proposed powered ankle/toe prothesis is the first device to match the weight, size, and build height of microprocessor-controlled prostheses.

Design of 3D printable prosthetic foot to implement nonlinear stiffness behavior of human toe joint based on finite element analysis

Toe joint is known as one of the critical factors in designing a prosthetic foot due to its nonlinear stiffness characteristic. This stiffness characteristic provides a general feeling of springiness in the toe-off and it also affects the ankle kinetics. In this study, the toe part of the prosthetic foot was designed to improve walking performance. The toe joint was implemented as a single part suitable for 3D printing. The various shape factors such as curved shape, bending space, auxetic structure, and bending zone were applied to mimic human foot characteristics. The finite element analysis (FEA) was conducted to simulate terminal stance (from heel-off to toe-off) using the designed prosthetic foot. To find the structure with characteristics similar to the human foot, the optimization was performed based on the toe joint geometries. As a result, the optimized foot showed good agreement with human foot behavior in the toe torque-angle curve. Finally, the simulation conditions were validated by comparing with human walking data and it was confirmed that the designed prosthetic foot structure can implement the human foot function.

Muscle as a tunable material: implications for achieving muscle-like function in robotic prosthetic devices

An ideal prosthesis should perform as well as or better than the missing limb it was designed to replace. Although this ideal is currently unattainable, recent advances in design have significantly improved the function of prosthetic devices. For the lower extremity, both passive prostheses (which provide no added power) and active prostheses (which add propulsive power) aim to emulate the dynamic function of the ankle joint, whose adaptive, time-varying resistance to applied forces is essential for walking and running. Passive prostheses fail to normalize energetics because they lack variable ankle impedance that is actively controlled within each gait cycle. By contrast, robotic prostheses can normalize energetics for some users under some conditions. However, the problem of adaptive and versatile control remains a significant issue. Current prosthesis-control algorithms fail to adapt to changes in gait required for walking on level ground at different speeds or on ramps and stairs. A new paradigm of 'muscle as a tunable material' versus 'muscle as a motor' offers insights into the adaptability and versatility of biological muscles, which may provide inspiration for prosthesis design and control. In this new paradigm, neural activation tunes muscle stiffness and damping, adapting the response to applied forces rather than instructing the timing and amplitude of muscle force. A mechanistic understanding of muscle function is incomplete and would benefit from collaboration between biologists and engineers. An improved understanding of the adaptability of muscle may yield better models as well as inspiration for developing prostheses that equal or surpass the functional capabilities of biological limbs across a wide range of conditions.

Task dependent changes in mechanical and biomechanical measures result from manipulating stiffness settings in a prosthetic foot

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.

Adapting Semi-Active Prostheses to Real-World Movements: Sensing and Controlling the Dynamic Mean Ankle Moment Arm with a Variable-Stiffness Foot on Ramps and Stairs

(1) Background: Semi-active prosthetic feet can provide adaptation in different circumstances, enabling greater function with less weight and complexity than fully powered prostheses. However, determining how to control semi-active devices is still a challenge. The dynamic mean ankle moment arm (DMAMA) provides a suitable biomechanical metric, as its simplicity matches that of a semi-active device. However, it is unknown how stiffness and locomotion modes affect DMAMA, which is necessary to create closed-loop controllers for semi-active devices. In this work, we develop a method to use only a prosthesis-embedded load sensor to measure DMAMA and classify locomotion modes, with the goal of achieving mode-dependent, closed-loop control of DMAMA using a variable-stiffness prosthesis. We study how stiffness and ground incline affect the DMAMA, and we establish the feasibility of classifying locomotion modes based exclusively on the load sensor. (2) Methods: Human subjects walked on level ground, ramps, and stairs while wearing a variable-stiffness prosthesis in low-, medium-, and high-stiffness settings. We computed DMAMA from sagittal load sensor data and prosthesis geometric measurements. We used linear mixed-effects models to determine subject-independent and subject-dependent sensitivity of DMAMA to incline and stiffness. We also used a machine learning model to classify locomotion modes using only the load sensor. (3) Results: We found a positive linear sensitivity of DMAMA to stiffness on ramps and level ground. Additionally, we found a positive linear sensitivity of DMAMA to ground slope in the low- and medium-stiffness conditions and a negative interaction effect between slope and stiffness. Considerable variability suggests that applications of DMAMA as a control input should look at the running average over several strides. To examine the efficacy of real-time DMAMA-based control systems, we used a machine learning model to classify locomotion modes using only the load sensor. The classifier achieved over 95% accuracy. (4) Conclusions: Based on these findings, DMAMA has potential for use as a closed-loop control input to adapt semi-active prostheses to different locomotion modes.

Understanding patient preference in prosthetic ankle stiffness

BACKGROUND

User preference has the potential to facilitate the design, control, and prescription of prostheses, but we do not yet understand which physiological factors drive preference, or if preference is associated with clinical benefits.

METHODS

Subjects with unilateral below-knee amputation walked on a custom variable-stiffness prosthetic ankle and manipulated a dial to determine their preferred prosthetic ankle stiffness at three walking speeds. We evaluated anthropomorphic, metabolic, biomechanical, and performance-based descriptors at stiffness levels surrounding each subject's preferred stiffness.

RESULTS

Subjects preferred lower stiffness values at their self-selected treadmill walking speed, and elected to walk faster overground with ankle stiffness at or above their preferred stiffness. Preferred stiffness maximized the kinematic symmetry between prosthetic and unaffected joints, but was not significantly correlated with body mass or metabolic rate.

CONCLUSION

These results imply that some physiological factors are weighted more heavily when determining preferred stiffness, and that preference may be associated with clinically relevant improvements in gait.

A passive mechanism for decoupling energy storage and return in ankle-foot prostheses: A case study in recycling collision energy

Individuals with lower limb amputation experience reduced ankle push-off work in the absence of functional muscles spanning the joint, leading to decreased walking performance. Conventional energy storage and return (ESR) prostheses partially compensate by storing mechanical energy during midstance and returning this energy during the terminal stance phase of gait. These prostheses can provide approximately 30% of the push-off work performed by a healthy ankle-foot during walking. Novel prostheses that return more normative levels of mechanical energy may improve walking performance. In this work, we designed a Decoupled ESR (DESR) prosthesis which stores energy usually dissipated at heel-strike and loading response, and returns this energy during terminal stance, thus increasing the mechanical push-off work done by the prosthesis. This decoupling is achieved by switching between two different cam profiles that produce distinct, nonlinear torque-angle mechanics. The cams automatically interchange at key points in the gait cycle via a custom magnetic switching system. Benchtop characterization demonstrated the successful decoupling of energy storage and return. The DESR mechanism was able to capture energy at heel-strike and loading response, and return it later in the gait cycle, but this recycling was not sufficient to overcome mechanical losses. In addition to its potential for recycling energy, the DESR mechanism also enables unique mechanical customizability, such as dorsiflexion during swing phase for toe clearance, or increasing the rate of energy release at push-off.

Variable stiffness foot design and validation

Energy storing and returning prosthetic feet are commonly prescribed. Research has demonstrated advantages to use these types of prosthetic feet. However, their stiffness in the sagittal plane is fixed and cannot adapt to different walking tasks and user preference. In this paper, we propose a novel prosthetic foot design capable of modulating its stiffness in the sagittal plane. The Variable Stiffness Ankle unit (VSA) is mounted on a commercially available prosthetic foot. The stiffness of the foot is adjusted with a lightweight servo motor controlled wirelessly. The stiffness change is accomplished by moving the supports points on the glass fiber leaf spring of the VSA ankle unit. We described the design and characterized changes in ankle stiffness using a mechanical test bench. A novel method was used to capture mechanical test data using a six degree of freedom load cell, allowing us to contrast mechanical and biomechanical data. A transtibial unilateral amputee performed level ground walking on an instrumented treadmill. The VSA prosthetic foot exhibited ankle stiffness change in the mechanical test bench. Ankle stiffness changes were also confirmed during the biomechanical analysis. Future work will involve additional subjects. The VSA prosthetic foot could improve user satisfaction and help prosthetist to fine tune prosthetic feet during fittings.

Experimental Demonstration of the Lower Leg Trajectory Error Framework Using Physiological Data as Inputs

While many studies have attempted to characterize the mechanical behavior of passive prosthetic feet to understand their influence on amputee gait, the relationship between mechanical design and biomechanical performance has not yet been fully articulated from a fundamental physics perspective. A novel framework, called lower leg trajectory error (LLTE) framework, presents a means of quantitatively optimizing the constitutive model of prosthetic feet to match a reference kinematic and kinetic dataset. This framework can be used to predict the required stiffness and geometry of a prosthesis to yield a desired biomechanical response. A passive prototype foot with adjustable ankle stiffness was tested by a unilateral transtibial amputee to evaluate this framework. The foot condition with LLTE-optimal ankle stiffness enabled the user to replicate the physiological target dataset within 16% root-mean-square (RMS) error. Specifically, the measured kinematic variables matched the target kinematics within 4% RMS error. Testing a range of ankle stiffness conditions from 1.5 to 24.4 N·m/deg with the same user indicated that conditions with lower LLTE values deviated the least from the target kinematic data. Across all conditions, the framework predicted the horizontal/vertical position, and angular orientation of the lower leg during midstance within 1.0 cm, 0.3 cm, and 1.5 deg, respectively. This initial testing suggests that prosthetic feet designed with low LLTE values could offer benefits to users. The LLTE framework is agnostic to specific foot designs and kinematic/kinetic user targets, and could be used to design and customize prosthetic feet.

A Semi-Powered Ankle Prosthesis and Unified Controller for Level and Sloped Walking

This paper describes a semi-powered ankle prosthesis and corresponding unified controller that provides biomimetic behavior for level and sloped walking without requiring identification of ground slope or modulation of control parameters. The controller is based on the observation that healthy individuals maintain an invariant external quasi-stiffness (spring like behavior between the shank and ground) when walking on level and sloped terrain. Emulating an invariant external quasi-stiffness requires an ankle that can vary the set-point (i.e., equilibrium angle) of the ankle stiffness. A semi-powered ankle prosthesis that incorporates a novel constant-volume power-asymmetric actuator was developed to provide this behavior, and the unified controller was implemented on it. The device and unified controller were assessed on three subjects with transtibial amputations while walking on inclines, level ground, and declines. Experimental results suggest that the prosthesis and accompanying controller can provide a consistent external quasi-stiffness similar to healthy subjects across all tested ground slopes.

The effects of ground-irregularity-cancelling prosthesis control on balance over uneven surfaces

Over half of individuals with a lower-limb amputation are unable to walk on uneven terrain. Using a prosthesis emulator system, we developed an irregularity-cancelling controller intended to reduce the effect of disturbances resulting from uneven surfaces. This controller functions by changing the neutral angles of two forefoot digits in response to local terrain heights. To isolate the effects of the controller, we also programmed a spring-like controller that maintained fixed neutral angles. Five participants with transtibial amputation walked on a treadmill with an uneven walking surface. Compared with the spring-like controller, the irregularity-cancelling controller reduced ankle torque variability by 41% in the sagittal plane and 64% in the frontal plane. However, user outcomes associated with balance were mostly unaffected; only trunk movement variability was reduced, whereas metabolic rate, mediolateral centre of mass motion, and variabilities in step width, step length and step time were unchanged. We conclude that reducing ankle torque variability of the affected limb is not sufficient for reducing the overall effect of disturbances due to uneven terrain. It is possible that other factors, such as changes in step height or disturbances to the intact limb, play a larger role in difficulty balancing while walking over uneven surfaces.

Speed Adaptable Prosthetic Foot: Concept Description, Prototyping and Initial User Testing

This article presents a novel design of a prosthetic foot that features adaptable stiffness that changes according to the speed of ankle motion. The motivation is the natural graduation in stiffness of a biological ankle over a range of ambulation tasks. The device stiffness depends on rate of movement, ranging from a dissipating support at very slow walking speed, to efficient energy storage and return at normal walking speed. The objective here is to design a prosthetic foot that provides a compliant support for slow ambulation, without sacrificing the spring-like energy return beneficial in normal walking. The design is a modification of a commercially available foot and employs material properties to provide a change in stiffness. The velocity dependent properties of a non-Newtonian working fluid provide the rate adaptability. Material properties of components allow for a geometry shift that results in a coupling action, affecting the stiffness of the overall system. The function of an adaptive coupling was tested in linear motion. A prototype prosthetic foot was built, and the speed dependent stiffness measured mechanically. Furthermore, the prototype was tested by a user and body kinematics measured in gait analysis for varying walking speed, comparing the prototype to the original foot model (non-modified). Mechanical evaluation of stiffness shows increase in stiffness of about 60% over the test range and 10% increase between slow and normal walking speed in user testing.

Comparing preference of ankle-foot stiffness in below-knee amputees and prosthetists

When fitting prosthetic feet, prosthetists fuse information from their visual assessment of patient gait with the patient's communicated perceptions and preferences. In this study, we sought to simultaneously and independently assess patient and prosthetist preference for prosthetic foot stiffness using a custom variable-stiffness prosthesis. In the first part of the experiment, seven subjects with below-knee amputation walked on the variable-stiffness prosthetic foot set to a randomized stiffness, while several prosthetist subjects simultaneously observed their gait. After each trial, the amputee subjects and prosthetist subjects indicated the change to stiffness that they would prefer (increase or decrease). This paradigm allowed us to simultaneously measure amputee subject and prosthetist subject preferences, and provided a reliability index indicating the consistency of their preferences. In the second part of the experiment, amputee subjects were instructed to communicate verbally with one prosthetist subject to arrive at a mutually preferred stiffness. On average, prosthetist subjects preferred a 26% higher stiffness than amputee subjects (p < 0.001), though this depended on the amputee subject (p < 0.001). Prosthetist subjects were also considerably less consistent than amputee subjects in their preferences (CV of 5.6% for amputee subjects, CV of 23% for prosthetist subjects; p = 0.014). Mutual preference seemed to be dictated by the specific patient-prosthetist dynamic, and no clear trends emerged.

Ankle Control in Walking and Running: Speed- and Gait-Related Changes in Dynamic Mean Ankle Moment Arm

The human foot-ankle complex uses heel-to-toe ground contact progression in walking, but primarily forefoot contact in high-speed running. This qualitative change in ankle control is clear to the runner, but current measures of ankle behavior cannot isolate the effect, and it is unknown how it changes across moderate speeds. We investigated this dynamic ankle control across a range of walking and running speeds using a new measure, the dynamic mean ankle moment arm (DMAMA): the ratio of sagittal ankle moment impulse to ground reaction force impulse on a single limb. We hypothesized that DMAMA would increase with speed in both walking and running, indicating more forefoot-dominated gait with ground reaction forces more anterior to the ankle. Human subjects walked (1.0-2.0 m/s) and ran (2.25-5.25 m/s) on an instrumented treadmill with motion capture and pressure insoles to estimate DMAMA. DMAMA decreased with increasing walking speed, then increased upon the transition to running, and increased further with increasing running speed. These results provide quantitative evidence that walking becomes more hindfoot-dominated as speed increases-similar to behavior during acceleration-and that running is more forefoot-dominated than walking. The instantaneous center of pressure (COP) at initial ground contact did not follow the same trends. The discrepancy highlights the value of DMAMA in summarizing ankle control across the whole stance phase. DMAMA may provide a useful outcome metric for evaluating biomimetic prostheses and for quantifying foot contact styles in running.

Neuromotor Regulation of Ankle Stiffness is Comparable to Regulation of Joint Position and Torque at Moderate Levels

Joint mechanical impedance, which describes the instantaneous relationship between kinematic perturbations and the resulting torque response, plays an important role in the way humans ambulate, interact with the environment, and respond to disturbances. Recent studies have quantified how the stiffness component of mechanical impedance varies during walking. However, the extent to which humans can voluntarily regulate leg joint stiffness is not yet known. Our study sought to quantify the accuracy and precision of the neuromotor system to voluntarily regulate ankle joint stiffness while seated, and compare these data to the well-known abilities to regulate ankle joint torque and position. We tested individuals’ ability to to regulate these quantities at three different magnitudes: 20%, 40%, and 60% of a maximum value. Our results showed that subjects were able to voluntarily regulate ankle joint stiffness, and that the normalized accuracy and precision of stiffness regulation were not different than those of position or torque for targets at magnitudes of 20% of a maximum value. However, the accuracy and precision of stiffness regulation were statistically different than those of position and torque for targets at magnitudes of 40% of the maximum values. At moderate targets, the similarity of the ability to regulate ankle joint stiffness when compared to the abilities to regulate joint torque and position highlights the importance of a comprehensive description of lower-limb biomechanics that includes consideration of joint mechanical impedance, in addition to the common descriptions of joint torque and position.

Real-Time Interface Algorithm for Ankle Kinematics and Stiffness From Electromyographic Signals

Shortcomings in capabilities of below-knee (transtibial) prostheses, compared to their biological counterparts, still cause medical complications and functional deficit to millions of amputees around the world. Although active (powered actuation) transtibial prostheses have the potential to bridge these gaps, the current control solutions limit their efficacy. Here we describe the development of a novel interface for two degrees-of-freedom position and stiffness control for below-knee amputees. The developed algorithm for the interface relies entirely on muscle electrical signals from the lower leg. The algorithm was tested for voluntary position and stiffness control in eight able-bodied and two transtibial amputees and for voluntary stiffness control with foot position estimation while walking in eight able-bodied and one transtibial amputee. The results of the voluntary control experiment demonstrated a promising target reaching success rate, higher for amputees compared to the able-bodied individuals (82.5% and 72.5% compared to 72.5% and 68.1% for the position and position and stiffness matching tasks respectively). Further, the algorithm could provide the means to control four stiffness levels during walking in both amputee and able-bodied individuals while providing estimates of foot kinematics (gait cycle cross-correlation >75% for the sagittal and >90% for the frontal plane and gait cycle root mean square error <7.5° in sagittal and <3° in frontal plane for able-bodied and amputee individuals across three walking speeds). The results from the two experiments demonstrate the feasibility of using this novel algorithm for online control of multiple degrees of freedom and of their stiffness in lower limb prostheses.

Use of Dynamic FEA for Design Modification and Energy Analysis of a Variable Stiffness Prosthetic Foot

Different tasks and conditions in gait call for different stiffness of prosthetic foot devices. The following work presents a case study on design modifications of a prosthetic foot, aimed at variable stiffness of the device. The objective is a proof-of-concept, achieved by simulating the modifications using finite element modeling. Design changes include the addition of a controlled damping element, connected both in parallel and series to a system of springs. The aim is to change the stiffness of the device under dynamic loading, by applying a high damping constant, approaching force coupling for the given boundary conditions. The dynamic modelling simulates mechanical test methods used to measure load response in full roll-over of prosthetic feet. Activation of the element during loading of the foot justifies the damped effect. As damping is in contrast to the main design objectives of energy return in prosthetic feet, it is considered important to quantify the dissipated energy in such an element. Our design case shows that the introduction of a damping element, with a high damping constant, can increase the overall rotational stiffness of the device by 50%. Given a large enough damping coefficient, the energy dissipation in the active element is about 20% of maximum strain energy.

Impedance Control Strategies for Enhancing Sloped and Level Walking Capabilities for Individuals with Transfemoral Amputation Using a Powered Multi-Joint Prosthesis

INTRODUCTION

Powered prostheses are a promising new technology that may help people with lower-limb loss improve their ability to perform locomotion tasks. Developing active prostheses requires robust design methodologies and intelligent controllers to appropriately provide assistance to the user for varied tasks in different environments. The purpose of this study was to validate an impedance control strategy for a powered knee and ankle prosthesis using an embedded sensor suite of encoders and a six-axis load cell that would aid an individual in performing common locomotion tasks, such as level walking and ascending/descending slopes.

MATERIALS AND METHODS

Three amputees walked on a treadmill and four amputees walked on a ramp circuit to test whether a dual powered knee and ankle prosthesis could generate appropriate device joint kinematics across users.

RESULTS

Investigators found that tuning 2-3 subject-specific parameters per ambulation mode was necessary to render individualized assistance. Furthermore, the kinematic profiles demonstrate invariance to walking speeds ranging from 0.63 to 1.07 m/s and incline/decline angles ranging from 7.8° to 14°.

CONCLUSION

This work presents a strategy that requires minimal tuning for a powered knee & ankle prosthesis that scales across a nominal range of both walking speeds and ramp slopes.

The effects of ankle stiffness on mechanics and energetics of walking with added loads: a prosthetic emulator study

BACKGROUND

The human ankle joint has an influential role in the regulation of the mechanics and energetics of gait. The human ankle can modulate its joint 'quasi-stiffness' (ratio of plantarflexion moment to dorsiflexion displacement) in response to various locomotor tasks (e.g., load carriage). However, the direct effect of ankle stiffness on metabolic energy cost during various tasks is not fully understood. The purpose of this study was to determine how net metabolic energy cost was affected by ankle stiffness while walking under different force demands (i.e., with and without additional load).

METHODS

Individuals simulated an amputation by using an immobilizer boot with a robotic ankle-foot prosthesis emulator. The prosthetic emulator was controlled to follow five ankle stiffness conditions, based on literature values of human ankle quasi-stiffness. Individuals walked with these five ankle stiffness settings, with and without carrying additional load of approximately 30% of body mass (i.e., ten total trials).

RESULTS

Within the range of stiffness we tested, the highest stiffness minimized metabolic cost for both load conditions, including a ~ 3% decrease in metabolic cost for an increase in stiffness of about 0.0480 Nm/deg/kg during normal (no load) walking. Furthermore, the highest stiffness produced the least amount of prosthetic ankle-foot positive work, with a difference of ~ 0.04 J/kg from the highest to lowest stiffness condition. Ipsilateral hip positive work did not significantly change across the no load condition but was minimized at the highest stiffness for the additional load conditions. For the additional load conditions, the hip work followed a similar trend as the metabolic cost, suggesting that reducing positive hip work can lower metabolic cost.

CONCLUSION

While ankle stiffness affected the metabolic cost for both load conditions, we found no significant interaction effect between stiffness and load. This may suggest that the importance of the human ankle's ability to change stiffness during different load carrying tasks may not be driven to minimize metabolic cost. A prosthetic design that can modulate ankle stiffness when transitioning from one locomotor task to another could be valuable, but its importance likely involves factors beyond optimizing metabolic cost.

Ankle Mechanical Impedance During the Stance Phase of Running

OBJECTIVE

Differences in locomotor biomechanics between walking and running provide fundamental information about human ambulation. Joint mechanical impedance is a biomechanical property that governs the body's instantaneous response to disturbances, and is important for stability and energy transfer. Ankle impedance has been characterized during walking, but little is known about how humans alter joint impedance during running. The purpose of this study was to estimate ankle impedance during the stance phase of running, and compare to previously reported estimates during walking.

METHODS

Perturbations were applied to the ankle using a one-degree-of-freedom (DOF) mechatronic platform. Least-squares system identification was performed using a parametric model consisting of stiffness, damping, and inertia.

RESULTS

The model accounted for 89% ± 16% of variance. Ankle stiffness reached a maximum of 10 Nm/rad/kg at the end of mid-stance, decreasing in terminal stance phase to values previously reported during swing phase. Quasi-stiffness values differed significantly from stiffness across the stance phase of running. Comparing ankle impedance estimates between walking and running showed differences in both magnitude, and temporal variation.

CONCLUSION

Ankle impedance differs significantly between walking and running.

SIGNIFICANCE

This study provides novel information about the biomechanics of running and broadens our understanding of how the mechanical impedance of the ankle joint differs between locomotor tasks, motivating the need for future studies.

Design Optimization in Lower Limb Prostheses: A Review

This paper aims to develop a knowledge base and identify the promising research pathways toward designing lower limb prostheses for optimal biomechanical and clinical outcomes. It is based on the literature search representing the state of the art in the lower limb prosthesis joint design and biomechanical analysis. Current design solutions are organized in terms of fulfilling four key functional roles: body support, propulsion, task flexibility, and loading relief. Biomechanical analyses of these designs reveal that the hypothesized outcomes are not consistently observed. We suggest that these outcomes may be improved by incorporating tools that can predict user performance metrics to optimize the device during the initial design process. We also note that the scope of the solution space of most current designs is limited by focusing on the anthropomorphic design approaches that do not account for the person's altered anatomy post-amputation. The effects of the prosthetic joint behavior on whole-body gait biomechanics and user experience are likewise under-explored. Two research paths to support the goal of better predicting the user outcomes are proposed: experimental parameterization of designs and model-based simulations. However, while work in these areas has introduced promising new possibilities, connecting both to improve real-world performance remains a challenge.