Effects of a Powered Knee-Ankle Prosthesis on Amputee Hip Compensations: A Case Series

Comparing the lower limb joint biomechanics of the Power Knee, C-Leg and Rheo Knee during ramp and stair ambulation

One of the most significant developments in prosthetic knee technology has been the introduction of the Microprocessor-Controlled Prosthetic Knee (MPK). However, there is a lack of consensus over how different types of MPKs affect performance in different ambulation modes. In this study, we investigated the biomechanical differences in ramp and stair maneuvers when an individual with transfemoral amputation wears three commercial MPKs: the Össur Power Knee, the Össur Rheo Knee and the Ottobock C-Leg 4. The primary outcome variable for this study was the lower limb biological joint work, inclusive of the intact leg and prosthetic side hip. We hypothesized that (1) the Power Knee would result in lower biological work during ascent activities than the C-Leg and Rheo, both passive MPKs, and (2) the C-Leg and Rheo would result in lower biological work during descent activities than the Power Knee. During ramp ascent, the C-Leg was associated with lower biological joint work (p < 0.05) than the Power Knee. However, this relationship did not hold during stair ascent, where the Power Knee showed advantages for stair ascent with net reductions in biological joint work of 14.1% and 23.3% compared to the Rheo and C-leg, respectively. There were no significant differences in biological joint work between the knees during ramp and stair descent, indicating that choice of MPK may not be as important for descent activities. Our results demonstrate that differences are present between different types of MPKs during ascent activities which could prove useful in the prescription of these devices.

Data-Driven Phase-Based Control of a Powered Knee-Ankle Prosthesis for Variable-Incline Stair Ascent and Descent

Powered knee-ankle prostheses can offer benefits over conventional passive devices during stair locomotion by providing biomimetic net-positive work and active control of joint angles. However, many modern control approaches for stair ascent and descent are often limited by time-consuming hand-tuning of user/task-specific parameters, predefined trajectories that remove user volition, or heuristic approaches that cannot be applied to both stair ascent and descent. This work presents a phase-based hybrid kinematic and impedance controller (HKIC) that allows for semi-volitional, biomimetic stair ascent and descent at a variety of step heights. We define a unified phase variable for both stair ascent and descent that utilizes lower-limb geometry to adjust to different users and step heights. We extend our prior data-driven impedance model for variable-incline walking, modifying the cost function and constraints to create a continuously-varying impedance parameter model for stair ascent and descent over a continuum of step heights. Experiments with above-knee amputee participants (N=2) validate that our HKIC controller produces biomimetic ascent and descent joint kinematics, kinetics, and work across four step height configurations. We also show improved kinematic performance with our HKIC controller in comparison to a passive microprocessor-controlled device during stair locomotion.

Functional Performance Outcomes of a Powered Knee-Ankle Prosthesis in Service Members With Unilateral Transfemoral Limb Loss

INTRODUCTION

Clinical knowledge surrounding functional outcomes of a powered knee-ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training.

MATERIALS AND METHODS

Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment.

RESULTS

All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis.

CONCLUSIONS

Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.

Data-Driven Variable Impedance Control of a Powered Knee-Ankle Prosthesis for Adaptive Speed and Incline Walking

Most impedance-based walking controllers for powered knee-ankle prostheses use a finite state machine with dozens of user-specific parameters that require manual tuning by technical experts. These parameters are only appropriate near the task (e.g., walking speed and incline) at which they were tuned, necessitating many different parameter sets for variable-task walking. In contrast, this paper presents a data-driven, phase-based controller for variable-task walking that uses continuously-variable impedance control during stance and kinematic control during swing to enable biomimetic locomotion. After generating a data-driven model of variable joint impedance with convex optimization, we implement a novel task-invariant phase variable and real-time estimates of speed and incline to enable autonomous task adaptation. Experiments with above-knee amputee participants (N=2) show that our data-driven controller 1) features highly-linear phase estimates and accurate task estimates, 2) produces biomimetic kinematic and kinetic trends as task varies, leading to low errors relative to able-bodied references, and 3) produces biomimetic joint work and cadence trends as task varies. We show that the presented controller meets and often exceeds the performance of a benchmark finite state machine controller for our two participants, without requiring manual impedance tuning.

Development of an Integrated Powered Hip and Microprocessor-Controlled Knee for a Hip-Knee-Ankle-Foot Prosthesis

Hip-knee-ankle-foot prostheses (HKAF) are full lower-limb devices for people with hip amputations that enable individuals to regain their mobility and move freely within their chosen environment. HKAFs typically have high rejection rates among users, as well as gait asymmetry, increased trunk anterior-posterior lean, and increased pelvic tilt. A novel integrated hip-knee (IHK) unit was designed and evaluated to address the limitations of existing solutions. This IHK combines powered hip and microprocessor-controlled knee joints into one structure, with shared electronics, sensors, and batteries. The unit is also adjustable to user leg length and alignment. ISO-10328:2016 standard mechanical proof load testing demonstrated acceptable structural safety and rigidity. Successful functional testing involved three able-bodied participants walking with the IHK in a hip prosthesis simulator. Hip, knee, and pelvic tilt angles were recorded and stride parameters were analyzed from video recordings. Participants were able to walk independently using the IHK and data showed that participants used different walking strategies. Future development of the thigh unit should include completion of a synergistic gait control system, improved battery-holding mechanism, and amputee user testing.

Low limb prostheses and complex human prosthetic interaction: A systematic literature review

A few years ago, powered prostheses triggered new technological advances in diverse areas such as mobility, comfort, and design, which have been essential to improving the quality of life of individuals with lower limb disability. The human body is a complex system involving mental and physical health, meaning a dependant relationship between its organs and lifestyle. The elements used in the design of these prostheses are critical and related to lower limb amputation level, user morphology and human-prosthetic interaction. Hence, several technologies have been employed to accomplish the end user's needs, for example, advanced materials, control systems, electronics, energy management, signal processing, and artificial intelligence. This paper presents a systematic literature review on such technologies, to identify the latest advances, challenges, and opportunities in developing lower limb prostheses with the analysis on the most significant papers. Powered prostheses for walking in different terrains were illustrated and examined, with the kind of movement the device should perform by considering the electronics, automatic control, and energy efficiency. Results show a lack of a specific and generalised structure to be followed by new developments, gaps in energy management and improved smoother patient interaction. Additionally, Human Prosthetic Interaction (HPI) is a term introduced in this paper since no other research has integrated this interaction in communication between the artificial limb and the end-user. The main goal of this paper is to provide, with the found evidence, a set of steps and components to be followed by new researchers and experts looking to improve knowledge in this field.

Design, fabrication and experiments of a hydraulic active-passive hybrid prosthesis knee

BACKGROUND

Due to low friction, passive mechanical prostheses move compliantly followed by the stump and are used widely. Advanced semi-active prostheses can both move passively like passive prostheses and provide active torque under specific conditions. However, the current mechanical-hydraulic coupling driven semi-active prostheses, in order to meet the low passive friction requirements with a low active transmission ratio, lead to a significant problem of insufficient active torque.

OBJECTIVE

A hybrid active and passive prosthesis was developed to solve the incompatibility problem of low passive friction and high active driving torque of semi-active prostheses.

METHODS

The mechanical structure and control strategy of the prosthesis were demonstrated. The performance of the prosthesis was tested by bench and human tests.

RESULTS

Passive subsystem damping adjustment ranges from 0.4 N⋅(mm/s)-1 to 300 N⋅(mm/s)-1. The switching time between the damping and the active subsystem is 32 ± 2 ms. The continuous active torque output is more than 24 Nm. In level walking, the peak torque is about 28 Nm.

CONCLUSION

The proposed active-passive hybrid hydraulic prosthesis could satisfy both low passive friction and high active actuation.

Nonholonomic Virtual Constraints for Control of Powered Prostheses Across Walking Speeds

This paper presents a method to design a nonholonomic virtual constraint (NHVC) controller that produces multiple distinct stance-phase trajectories for corresponding walking speeds. NHVCs encode velocity-dependent joint trajectories via momenta conjugate to the unactuated degree(s)-of-freedom of the system. We recently introduced a method for designing NHVCs that allow for stable bipedal robotic walking across variable terrain slopes. This work extends the notion of NHVCs for application to variable-cadence powered prostheses. Using the segmental conjugate momentum for the prosthesis, an optimization problem is used to design a single stance-phase NHVC for three distinct walking speed trajectories (slow, normal, and fast). This stance-phase controller is implemented with a holonomic swing phase controller on a powered knee-ankle prosthesis, and experiments are conducted with an able-bodied user walking in steady and non-steady velocity conditions. The control scheme is capable of representing 1) multiple, task-dependent reference trajectories, and 2) walking gait variance due to both temporal and kinematic changes in user motion.

Toward Developing a Powered Ankle-Foot Prosthesis With Electromyographic Control to Enhance Functional Performance: A Case Study in a U.S. Service Member

The only commercially available ankle-foot prosthesis with powered propulsion lacks ruggedization and other capabilities for service members seeking to return to duty and/or other physically demanding activities. Here, we evaluated a ruggedized powered ankle-foot prosthesis with electromyographic control ("Warrior Ankle"; WA) in an experienced male user of the predicate (Empower) prosthesis. The participant (age = 56 years, mass = 86.8 kg, stature = 173 cm) completed a 650 m simulated hike with varying terrain at a fixed, self-selected speed in the WA and predicate prosthesis, with and without a 22.8 kg weighted vest ("loaded" and "unloaded," respectively). Peak dorsiflexion and plantarflexion angles were extracted from each gait cycle throughout the simulated hike (∼500 prosthetic-side steps). The participant walked faster with the WA (1.15 m/s) compared to predicate (0.80 m/s) prosthesis. On the prosthetic side, peak dorsiflexion angles were larger for the WA (loaded: 27.9°; unloaded: 26.9°) compared to the predicate (loaded: 19.4°; unloaded: 21.3°); peak plantarflexion angles were similar between prostheses and loading conditions [WA (loaded: 15.5°; unloaded: 14.9°), predicate (loaded: 16.9°; unloaded: 14.8°). The WA better accommodated the varying terrain profile, evidenced by greater peak dorsiflexion angles, as well as dorsiflexion and plantarflexion angles that more closely matched or exceeded those of the innate ankle [dorsiflexion (WA: 31.6°, predicate: 27.5°); plantarflexion (WA: 20.7°, predicate: 20.5°)]. Furthermore, the WA facilitated a faster walking speed, suggesting a greater functional capacity with the WA prosthesis. Although further design enhancements are needed, this case study demonstrated feasibility of a proof-of-concept, ruggedized powered ankle-foot prosthesis with electromyographic control.

Lower-limb kinematics and kinetics during continuously varying human locomotion

Human locomotion involves continuously variable activities including walking, running, and stair climbing over a range of speeds and inclinations as well as sit-stand, walk-run, and walk-stairs transitions. Understanding the kinematics and kinetics of the lower limbs during continuously varying locomotion is fundamental to developing robotic prostheses and exoskeletons that assist in community ambulation. However, available datasets on human locomotion neglect transitions between activities and/or continuous variations in speed and inclination during these activities. This data paper reports a new dataset that includes the lower-limb kinematics and kinetics of ten able-bodied participants walking at multiple inclines (±0°; 5° and 10°) and speeds (0.8 m/s; 1 m/s; 1.2 m/s), running at multiple speeds (1.8 m/s; 2 m/s; 2.2 m/s and 2.4 m/s), walking and running with constant acceleration (±0.2; 0.5), and stair ascent/descent with multiple stair inclines (20°; 25°; 30° and 35°). This dataset also includes sit-stand transitions, walk-run transitions, and walk-stairs transitions. Data were recorded by a Vicon motion capture system and, for applicable tasks, a Bertec instrumented treadmill.

Real-Time Activity Recognition With Instantaneous Characteristic Features of Thigh Kinematics

Current supervised learning or deep learning-based activity recognition classifiers can achieve high accuracy in recognizing locomotion activities. Most available techniques use a high-dimensional space of features, e.g., combinations of EMG, kinematics and kinetics, and transformations over those signals. The associated classification rules are therefore complex; the machine tries to understand the human, but the human does not understand the machine. This paper presents an activity recognition system that uses signals from a thigh-mounted IMU and a force sensitive resistor to classify transitions between sitting, walking, stair ascending, and stair descending. The system uses the thigh's orientation and velocity with foot contact information at specific moments within a given activity as the features to classify transitions to other activities. We call these Instantaneous Characteristic Features (ICFs). Because these ICFs are biomechanically intuitive, they are easy for the user to understand and thus control the activity transitions of wearable robots. We assessed our classification algorithm offline using an existing dataset with 10 able-bodied subjects and online with another 10 able-bodied subjects wearing a real-time system. The offline study analyzed the effect of subject-dependency and ramp inclinations. The real-time classification accuracy was evaluated before and after training the subjects on the ICFs. The real-time system achieved overall pre-subject-training and post-subject-training error rates of 0.59% ± 0.24% and 0.56% ± 0.20%, respectively. We also evaluated the feasibility of our ICFs for amputee ambulation by analyzing a public dataset with the open-source bionic leg. The simplicity of these classification rules demonstrates a new paradigm for activity recognition where the human can understand the machine and vice-versa.

Phase-Variable Control of a Powered Knee-Ankle Prosthesis over Continuously Varying Speeds and Inclines

Most controllers for lower-limb robotic prostheses require individually tuned parameter sets for every combination of speed and incline that the device is designed for. Because ambulation occurs over a continuum of speeds and inclines, this design paradigm requires tuning of a potentially prohibitively large number of parameters. This limitation motivates an alternative control framework that enables walking over a range of speeds and inclines while requiring only a limited number of tunable parameters. In this work, we present the implementation of a continuously varying kinematic controller on a custom powered knee-ankle prosthesis. The controller uses a phase variable derived from the residual thigh angle, along with real-time estimates of ground inclination and walking speed, to compute the appropriate knee and ankle joint angles from a continuous model of able-bodied kinematic data. We modify an existing phase variable architecture to allow for changes in speeds and inclines, quantify the closed-loop accuracy of the speed and incline estimation algorithms for various references, and experimentally validate the controller by observing that it replicates kinematic trends seen in able-bodied gait as speed and incline vary.

Toward Phase-Variable Control of Sit-to-Stand Motion with a Powered Knee-Ankle Prosthesis

This paper presents a new model and phase-variable controller for sit-to-stand motion in above-knee amputees. The model captures the effect of work done by the sound side and residual limb on the prosthesis, while modeling only the prosthetic knee and ankle with a healthy hip joint that connects the thigh to the torso. The controller is parametrized by a biomechanical phase variable rather than time and is analyzed in simulation using the model. We show that this controller performs well with minimal tuning, under a range of realistic initial conditions and biological parameters such as height and body mass. The controller generates kinematic trajectories that are comparable to experimentally observed trajectories in non-amputees. Furthermore, the torques commanded by the controller are consistent with torque profiles and peak values of normative human sit-to-stand motion. Rise times measured in simulation and in non-amputee experiments are also similar. Finally, we compare the presented controller with a baseline proportional-derivative controller demonstrating the advantages of the phase-based design over a set-point based design.

Analysis of Continuously Varying Kinematics for Prosthetic Leg Control Applications

Powered prosthetic legs can improve the quality of life for people with transfemoral amputations by providing net positive work at the knee and ankle, reducing the effort required from the wearer, and making more tasks possible. However, the controllers for these devices use finite state machines that limit their use to a small set of pre-defined tasks that require many hours of tuning for each user. In previous work, we demonstrated that a continuous parameterization of joint kinematics over walking speeds and inclines provides more accurate predictions of reference kinematics for control than a finite state machine. However, our previous work did not account for measurement errors in gait phase, walking speed, and ground incline, nor subject-specific differences in reference kinematics, which occur in practice. In this work, we conduct a pilot experiment to characterize the accuracy of speed and incline measurements using sensors onboard our prototype prosthetic leg and simulate phase measurements on ten able-bodied subjects using archived motion capture data. Our analysis shows that given demonstrated accuracy for speed, incline, and phase estimation, a continuous parameterization provides statistically significantly better predictions of knee and ankle kinematics than a comparable finite state machine, but both methods' primary source of predictive error is subject deviation from average kinematics.

Effects of a Powered Knee-Ankle Prosthesis on Amputee Hip Compensations: A Case Series

Transfemoral amputee gait often exhibits compensations due to the lack of ankle push-off power and control over swing foot position using passive prostheses. Powered prostheses can restore this functionality, but their effects on compensatory behaviors, specifically at the residual hip, are not well understood. This paper investigates residual hip compensations through walking experiments with three transfemoral amputees using a low-impedance powered knee-ankle prosthesis compared to their day-to-day passive prosthesis. The powered prosthesis used impedance control during stance for compliant interaction with the ground, a time-based push-off controller to deliver high torque and power, and phase-based trajectory tracking during swing to provide user control over foot placement. Experiments show that when subjects utilized the powered ankle push-off, less mechanical pull-off power was required from the residual hip to progress the limb forward. Overall positive work at the residual hip was reduced for 2 of 3 subjects, and negative work was reduced for all subjects. Moreover, all subjects displayed increased step length, increased propulsive impulses on the prosthetic side, and improved impulse symmetries. Hip circumduction improved for subjects who had previously exhibited this compensation on their passive prosthesis. These improvements in gait, especially reduced residual hip power and work, have the potential to reduce fatigue and overuse injuries in persons with transfemoral amputation.