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Toda H, Oshima T, Ibara T, Chin T. Longitudinal Alterations in the Control of Lateral Center of Mass Movement During Walking in a Patient With Unilateral Transtibial Amputation: A Case Study. Cureus 2024; 16:e61683. [PMID: 38975414 PMCID: PMC11223945 DOI: 10.7759/cureus.61683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
This study assessed longitudinal changes in the control of the center of mass (CoM) in the lateral direction through gait reacquisition in an individual with unilateral transtibial amputation (UTTA). We examined a male patient with UTTA who could walk on a parallel bar. The marker trajectories and ground reaction forces were measured every two weeks (total: four times) using an optical motion capture system and force plates. After two measurements, the samples were collected without a parallel bar. Subsequently, we evaluated the CoM movement and its segmental coordination through uncontrolled manifold (UCM) analysis. After the second measurement, the walking speed and step length increased. The lateral CoM movements gradually increased toward the prosthetic side until the third measurement. In the fourth measurement, the CoM movement towards the prosthetic side was the smallest and closest to the intact side at the end of the stance phase. In addition, segmental coordination improved significantly. Enhanced gait performance delayed the improvement of segmental coordination for CoM movement in the lateral direction.
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Affiliation(s)
- Haruki Toda
- Robot Rehabilitation Center, The Hyogo Institute of Assistive Technology, Kobe, JPN
| | - Takashi Oshima
- Orthopaedics, Hyogo Prefectural Rehabilitation Center, Kobe, JPN
| | - Takuya Ibara
- Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JPN
| | - Takaaki Chin
- Robot Rehabilitation Center, The Hyogo Institute of Assistive Technology, Kobe, JPN
- Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Center, Kobe, JPN
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Vaca M, Stine R, Hammond P, Cavanaugh M, Major MJ, Gard SA. The Effect of Prosthetic Ankle Dorsiflexion Stiffness on Standing Balance and Gait Biomechanics in Individuals with Unilateral Transtibial Amputation. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2022; 34:10.1097/JPO.0000000000000451. [PMID: 36407034 PMCID: PMC9670249 DOI: 10.1097/jpo.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Miguel Vaca
- Department of Biomedical Engineering - Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| | | | | | - Michael Cavanaugh
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| | - Matthew J. Major
- Department of Biomedical Engineering - Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
| | - Steven A. Gard
- Department of Biomedical Engineering - Northwestern University, Evanston, IL
- Jesse Brown VA Medical Center, Chicago, IL
- Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL
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Can microprocessor knees reduce the disparity in trips and falls risks between above and below knee prosthesis users? PLoS One 2022; 17:e0271315. [PMID: 36054087 PMCID: PMC9439191 DOI: 10.1371/journal.pone.0271315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
While all lower limb prosthesis walkers have a high risk of tripping and/or falling, above knee prosthesis users are reported to fall more frequently. Recognising this, engineers designed microprocessor knees (MPK) to help mitigate these risks, but to what extent these devices reduce this disparity between above and below knee users is unclear. A service review was carried out in a prosthetic limb centre regarding the frequency of trips and falls in the previous four weeks. Data from unilateral, community ambulators were extracted. Ordered logistic regressions were applied to investigate whether MPKs mitigated the increased risk of trips and falls for prosthetic knee users, compared to below knee prosthesis users. Socio-demographics (sex, age), prosthesis (prosthesis type, years of use), health (comorbidities, vision, contralateral limb status, medication), and physical function (use of additional walking aids, activity level) were included as covariates. Of the 315 participants in the analysis, 57.5% reported tripping and 20.3% reported falling. Non-microprocessor prosthetic knee (non-MPK) users were shown to trip significantly more than below knee prosthesis users (OR = 1.96, 95% CI = 1.17–3.28). Other covariates showing a significant association included contralateral limb injuries (OR = 1.91, 95% CI = 1.15–3.18) and using an additional walking aid (OR = 1.99, 95% CI = 1.13–3.50). Non-MPK users were also shown to fall significantly more than below knee prosthesis users (OR = 3.34, 95% CI = 1.73–6.45), with no other covariates showing a significant association. MPK users did not show an increased frequency of trips (OR = 0.74, 95% CI = 0.33–1.64) or falls (OR = 0.34, 95% CI = 0.18–2.62), compared to below knee prosthesis users. Of those who tripped at least once in the previous four weeks, those using a non-MPK (OR = 2.73, 95% CI = 1.30–5.74) presented an increased frequency of falling. These findings provide evidence to suggest that the use of MPKs reduces the difference in falls risk between above knee and below knee prosthesis users, providing justification for their provision.
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De Asha AR, Barnett CT. Calculated functional joint center positions are highly variable in individuals with unilateral transtibial amputation walking with identical prosthetic ankle-foot devices. Prosthet Orthot Int 2022; 46:91-94. [PMID: 34840279 DOI: 10.1097/pxr.0000000000000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Biomechanical modeling of the lower limbs, including prosthetic componentry, makes a number of assumptions that influence the data obtained and their subsequent interpretation. Calculated prosthetic ankle functional joint center (FJC) positions vary between devices and have been suggested as a possible method of comparing device function. OBJECTIVES The study aimed to assess the variability of joint center position estimates, calculated using an FJC methodology, in all three planes. This was assessed in participants with unilateral transtibial amputation using an identical prosthetic ankle-foot device during walking on a flat surface. STUDY DESIGN Case series. TECHNIQUE Three-dimensional motion capture recorded the position of markers placed on the shank and ankle-foot device of five individuals with unilateral transtibial amputation, as they completed 10 trials of level walking using the same ankle-foot device. The FJC between the prosthetic foot and shank segments were calculated for each trial. RESULTS The calculated FJC positions were highly variable across individual participants and within each individual. This variability was observed across all three planes of movement and resulted in calculated joint center positions created beyond the physical boundaries of the prosthetic device. CONCLUSIONS Biomechanical data are affected by lower limb and prosthetic device modeling assumptions. Definition of a prosthetic "ankle" joint using an FJC method results in highly variable "ankle" joint center positions when applied to a prosthetic ankle-foot device. Their use should be discouraged to avoid misleading interpretations of data.
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Affiliation(s)
- Alan R De Asha
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- C-Motion, Inc, Germantown, MD
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Christensen JC, Kline PW, Murray AM, Christiansen CL. Movement asymmetry during low and high demand mobility tasks after dysvascular transtibial amputation. Clin Biomech (Bristol, Avon) 2020; 80:105102. [PMID: 32768801 PMCID: PMC8793036 DOI: 10.1016/j.clinbiomech.2020.105102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/29/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Movement asymmetries between lower limbs are commonly exhibited by adults after transtibial amputation. However, the degree of movement asymmetry between low- and high-demand functional tasks remains unknown. METHODS Kinematic and kinetic data were collected during overground walking (low-demand) and step ascent (high-demand) tasks for two groups: 1) persons with transtibial amputation and 2) healthy matched peers. Analysis of covariance was used to compare sagittal-plane peak knee moment and joint angle (primary) and hip and ankle moments and joint angles, vertical ground reaction force and impulse (secondary). FINDINGS Within transtibial amputation group comparisons showed significantly greater between-limb asymmetry in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .05), peak ankle angle (p < .01) and peak ankle moment (p < .01) with the step ascent task compared to overground walking. The transtibial amputation group had greater between-limb asymmetry during step ascent in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .04) and peak ankle angle (p < .01) than healthy matched peers. During overground walking, the transtibial amputation group had greater between-limb asymmetry in peak vertical impulse (p = .05) and peak ankle moment (p < .01) than healthy matched peers. INTERPRETATION Movement asymmetry is increased during step ascent compared to overground walking for adults with transtibial amputation. While the restoration of overground walking is the focus of post-amputation rehabilitation and prosthetic design, higher demand tasks should also be considered to maximize mobility for adults with transtibial amputation.
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Affiliation(s)
- Jesse C Christensen
- University of Utah, Department of Physical Therapy and Athletic Training, United States of America; Veterans Affairs Salt Lake City Health Care System, United States of America; University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; Eastern Colorado Geriatric Research Education and Clinical Center, United States of America.
| | - Paul W Kline
- University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; High Point University, Department of Physical Therapy, United States of America.
| | - Amanda M Murray
- University of Toledo, School of Exercise & Rehabilitation Sciences, United States of America.
| | - Cory L Christiansen
- University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; Eastern Colorado Geriatric Research Education and Clinical Center, United States of America.
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Tryggvason H, Starker F, Armannsdottir AL, Lecomte C, Jonsdottir F. Speed Adaptable Prosthetic Foot: Concept Description, Prototyping and Initial User Testing. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2978-2986. [PMID: 33151884 DOI: 10.1109/tnsre.2020.3036329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs. Gait Posture 2020; 81:41-48. [PMID: 32663775 DOI: 10.1016/j.gaitpost.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimum Toe Clearance (MTC) is defined as the minimum vertical distance between the lowest point under the front part of the foot and the ground, during mid-swing. Low values of MTC and walking on inclines are both related to higher probability of tripping and falling in lower limb amputees. New prosthetic designs aim at improving MTC, especially on ramps, however the real effect on MTC still needs investigation. The objective of this study was then to evaluate the effect of different prosthetic designs on MTC in inclined walking. METHODS Thirteen transtibial amputees walked on a ramp using three different prostheses: non articulating ankle (NAA), articulating hydraulic ankle (AHA), and articulating hydraulic ankle with microprocessor (AHA-MP). Median MTC, coefficient of variation (CV), and tripping probability (TP) for obstacles of 10 and 15 mm were compared across ankle type in ascent and descent. FINDINGS When using AHA-MP, larger MTC median values for ascending (P ≤ 0.001, W = 0.58) and descending the ramp (P = 0.003, W = 0.47) were found in the prosthetic limb. Also significantly lower CV was found on the prosthetic limb for both types of AHA feet when compared to NAA for descending the ramp (P = 0.014, W = 0.45). AHA-MP showed the lowest TP for the prosthetic leg in three conditions evaluated. On the sound limb results showed the median MTC was significantly larger (P = 0.009, W = 0.43) and CV significantly lower (P = 0.005, W = 0.41) when using an AHA in ascent. INTERPRETATION Both AHA prosthetic designs help reduce the risk of tripping of the prosthetic limb by increasing the median MTC, lowering its variability and reducing TP for both legs when ascending and descending the ramp. For most of the conditions, AHA-MP showed the lowest TP values. Findings suggest that AHA prostheses, especially AHA-MP could reduce the risk of tripping on ramps in amputees.
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Müller R, Tronicke L, Abel R, Lechler K. Prosthetic push-off power in trans-tibial amputee level ground walking: A systematic review. PLoS One 2019; 14:e0225032. [PMID: 31743353 PMCID: PMC6863538 DOI: 10.1371/journal.pone.0225032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Unilateral trans-tibial amputation signifies a challenge to locomotion. Prosthetic ankle-foot units are developed to mimic the missing biological system which adapts push-off power to walking speed in some new prosthetic ankle-foot designs. The first systematic review including the two factors aims to investigate push-off power differences among Solid Ankle Cushion Heel (SACH), Energy Storage And Return (ESAR) and Powered ankle-foot units (PWR) and their relation to walking speed. DATA SOURCES A literature search was undertaken in the Web of Science, PubMed, IEEE xplore, and Google Scholar databases. The search term included: ampu* AND prosth* AND ankle-power AND push-off AND walking. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were included if they met the following criteria: unilateral trans-tibial amputees, lower limb prosthesis, reported analysis of ankle power during walking. Data extracted from the included studies were clinical population, type of the prosthetic ankle-foot units (SACH, ESAR, PWR), walking speed, and peak ankle power. Linear regression was used to determine whether the push-off power of different prosthetic ankle-foot units varied regarding walking speed. Push-off power of the different prosthetic ankle-foot units were compared using one-way between subjects' ANOVAs with post hoc analysis, separately for slower and faster walking speeds. RESULTS 474 publications were retrieved, 28 of which were eligible for inclusion. Correlations between walking speed and peak push-off power were found for ESAR (r = 0.568, p = 0.006) and PWR (r = 0.820, p = 0.000) but not for SACH (r = 0.267, p = 0.522). ESAR and PWR demonstrated significant differences in push-off power for slower and faster walking speeds (ESAR (p = 0.01) and PWR (p = 0.02)). CONCLUSION Push-off power can be used as a selection criterion to differentiate ankle-foot units for prosthetic users and their bandwidth of walking speeds.
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Affiliation(s)
- Roy Müller
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany
- Institute of Sport Sciences, Friedrich Schiller University Jena, Jena, Germany
| | | | - Rainer Abel
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany
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Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation. J Rehabil Assist Technol Eng 2019; 6:2055668318820784. [PMID: 31245027 PMCID: PMC6582291 DOI: 10.1177/2055668318820784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/22/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Diabetes and vascular disease represent the most common etiologies for lower
limb amputations. In lower limb loss rehabilitation, the prosthetic
ankle-foot mechanism is the most common major component needed to restore
function. The purpose of this study was to examine the impact of five common
prosthetic ankle-foot mechanisms on functional mobility in a large sample of
individuals with amputation due to diabetes/dysvascular disease. Methods A retrospective analysis of the Prosthetic Limb Users' Survey of Mobility
(PLUS-M®) captured in the patient care setting. A total of 738 individuals
were included and subsequently subdivided into five groups based on the
ankle-foot mechanism of their current prosthesis. Groups were compared using
a general linear univariate model with age, body mass index, comorbid health
status, time since amputation, and amputation level entered as
covariates. Results The microprocessor ankle-foot group had the highest mobility
(F4,728 = 3.845, p=0.004), which was followed by the vertical
loading pylon type ankle-foot, the hydraulic ankle-foot, the flex-walk-type
ankle-foot, and lastly the flex-foot-type ankle-foot. Conclusion These results demonstrate that the selection of different prosthetic
ankle-foot technology directly impacts functional mobility for the patient
with an amputation due to diabetes and/or vascular disease.
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Affiliation(s)
- Shane R Wurdeman
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA.,School of Allied Health Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA.,School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - James H Campbell
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
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McGrath M, Laszczak P, Zahedi S, Moser D. The influence of a microprocessor-controlled hydraulic ankle on the kinetic symmetry of trans-tibial amputees during ramp walking: A case series. J Rehabil Assist Technol Eng 2019; 5:2055668318790650. [PMID: 31191949 PMCID: PMC6453071 DOI: 10.1177/2055668318790650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/27/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Asymmetrical limb loading is believed to cause health problems for lower limb
amputees and is exacerbated when walking on slopes. Hydraulically damped
ankle-feet improve ground compliance on slopes compared to conventional
prosthetic feet. Microprocessor-controlled hydraulic ankle-feet provide
further adaptation by dynamically adjusting viscoelastic damping
properties. Method Using a case series design, gait analysis was performed with four
trans-tibial amputees. There were two walking conditions (ramp ascent and
descent) and two prosthetic foot conditions (microprocessor-control on and
off – MPF-on and MPF-off). Total support moment integral (MIsup) and degree-of-asymmetry were compared across foot
conditions. Results During ramp descent, the transition of prosthetic ankle moment from
dorsiflexion to plantarflexion occurred earlier in stance phase with MPF-on,
slowing the angular velocity of the shank. During ramp ascent, the MPF-on
dorsiflexion/plantarflexion moment transition occurred later, meaning less
resistance to shank rotation in early stance and increasing walking speed by
up to 6%. For both slope conditions, sound limb MIsup was universally decreased with MPF-on (4–13% descent,
3–11% ascent). Discussion Microprocessor-control of hydraulic ankle-feet reduced the total loading of
the sound limb joints, for both walking conditions, for all participants.
This may have beneficial consequences for long-term joint health and walking
efficiency.
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Strutzenberger G, Alexander N, De Asha A, Schwameder H, Barnett CT. Does an inverted pendulum model represent the gait of individuals with unilateral transfemoral amputation while walking over level ground? Prosthet Orthot Int 2019; 43:221-226. [PMID: 30168357 DOI: 10.1177/0309364618796847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: An inverted pendulum model represents the mechanical function of able-bodied individuals walking accurately, with centre of mass height and forward velocity data plotting as sinusoidal curves, 180° out of phase. OBJECTIVES: This study investigated whether the inverted pendulum model represented level gait in individuals with a unilateral transfemoral amputation. STUDY DESIGN: Controlled trial. METHODS: Kinematic and kinetic data from 10 individuals with unilateral transfemoral amputation and 15 able-bodied participants were recorded during level walking. RESULTS: During level walking, the inverted pendulum model described able-bodied gait well throughout the gait cycle, with median relative time shifts between centre of mass height and velocity maxima and minima between 1.2% and 1.8% of gait cycle. In the group with unilateral transfemoral amputation, the relative time shift was significantly increased during the prosthetic-limb initial double-limb support phase by 6.3%. CONCLUSION: The gait of individuals with unilateral transfemoral amputation shows deviation from a synchronous inverted pendulum model during prosthetic-limb stance. The reported divergence may help explain such individuals' increased metabolic cost of gait. Temporal divergence of inverted pendulum behaviour could potentially be utilised as a tool to assess the efficacy of prosthetic device prescription. CLINICAL RELEVANCE The size of the relative time shifts between centre of mass height and velocity maxima and minima could potentially be used as a tool to quantify the efficacy of innovative prosthetic device design features aimed at reducing the metabolic cost of walking and improving gait efficiency in individuals with amputation.
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Askew GN, McFarlane LA, Minetti AE, Buckley JG. Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid 'ankle': insights from body centre of mass dynamics. J Neuroeng Rehabil 2019; 16:39. [PMID: 30871573 PMCID: PMC6417010 DOI: 10.1186/s12984-019-0508-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown that use of a dynamic-response prosthetic foot (DRF) that incorporates a small passive hydraulic ankle device (hyA-F), provides certain biomechanical benefits over using a DRF that has no ankle mechanism (rigA-F). This study investigated whether use of a hyA-F in unilateral trans-tibial amputees (UTA) additionally provides metabolic energy expenditure savings and increases the symmetry in walking kinematics, compared to rigA-F. METHODS Nine active UTA completed treadmill walking trials at zero gradient (at 0.8, 1.0, 1.2, 1.4, and 1.6 of customary walking speed) and for customary walking speed only, at two angles of decline (5° and 10°). The metabolic cost of locomotion was determined using respirometry. To gain insights into the source of any metabolic savings, 3D motion capture was used to determine segment kinematics, allowing body centre of mass dynamics (BCoM), differences in inter-limb symmetry and potential for energy recovery through pendulum-like motion to be quantified for each foot type. RESULTS During both level and decline walking, use of a hyA-F compared to rigA-F significantly reduced the total mechanical work and increased the interchange between the mechanical energies of the BCoM (recovery index), leading to a significant reduction in the metabolic energy cost of locomotion, and hence an associated increase in locomotor efficiency (p < 0.001). It also increased inter-limb symmetry (medio-lateral and progression axes, particularly when walking on a 10° decline), highlighting the improvements in gait were related to a lessening of the kinematic compensations evident when using the rigA-F. CONCLUSIONS Findings suggest that use of a DRF that incorporates a small passive hydraulic ankle device will deliver improvements in metabolic energy expenditure and kinematics and thus should provide clinically meaningful benefits to UTAs' everyday locomotion, particularly for those who are able to walk at a range of speeds and over different terrains.
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Affiliation(s)
- Graham N Askew
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Laura A McFarlane
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Alberto E Minetti
- Department of Pathophysiology and Transplantation, Faculty of Medicine, University of Milan, Milan, Italy
| | - John G Buckley
- Division of Biomedical Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK.
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Hutchinson LA, Brown MJ, Deluzio KJ, De Asha AR. Self-Selected walking speed increases when individuals are aware of being recorded. Gait Posture 2019; 68:78-80. [PMID: 30465945 DOI: 10.1016/j.gaitpost.2018.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Typical gait data collections consist of discrete walking trials where participants are aware when data are being recorded. Anecdotally, some investigators have reported that participants often walk differently between trials or before or after data collection compared to when they know they are being recorded. In addition, walking speed, which affects a number of gait variables, is known to be different when individuals complete discrete and continuous walking trials. RESEARCH QUESTION The purpose of this study was to determine whether changes in walking speed occurred as a result of participants being aware, versus unaware that data were being recorded, during both discrete and continuous walking trials. METHODS Kinematic data were collected for twenty two individuals walking continuous trials or discrete trials, while they were both aware and unaware of being recorded. Comparisons of walking speeds were made between groups (continuous walking; discrete trials) and awareness of being recorded (aware; unaware) using a two way ANOVA. RESULTS The results indicated that participants walked significantly faster during discrete trials when they were aware that data were being recorded compared to when they were unaware. However, when they walked continuously their walking speed was not affected by their awareness. SIGNIFICANCE The results suggest that awareness of data collection, and the type of protocol used during data collection, affect an individual's walking speed during gait analysis. Therefore, care should be taken when determining gait analysis protocols where variables are sensitive to walking speeds.
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Affiliation(s)
| | | | | | - Alan R De Asha
- C-Motion Inc., Germantown, USA; School of Science and Technology, Nottingham Trent University, Nottingham, UK.
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Glanzer EM, Adamczyk PG. Design and Validation of a Semi-Active Variable Stiffness Foot Prosthesis. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2351-2359. [PMID: 30371376 DOI: 10.1109/tnsre.2018.2877962] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This paper presents the design and validation of a novel lower limb prosthesis called the variable stiffness foot (VSF), designed to vary its forefoot stiffness in response to user activity. The VSF is designed as a semi-active device that adjusts its stiffness once per stride during swing phases, in order to minimize size, mass, and power consumption. The forefoot keel is designed as an overhung composite beam, whose stiffness is varied by moving a support fulcrum to change the length of the overhang. Stiffness modulation is programmed in response to the gait characteristics detected through foot trajectory reconstruction based on an embedded inertial sensor. The prototype VSF has a mass of only 649 g including the battery, and a build height of 87 mm. Mechanical testing demonstrated a forefoot stiffness range of 10-32 N/mm for the prototype, a threefold range of stiffness variation. The stiffness range can be altered by changing the keel material or geometry. Actuation testing showed that the VSF can make a full-scale stiffness adjustment within three strides, and tracks moderate speed-driven variations within one swing phase. Human subjects testing demonstrated greater energy storage and return with lower stiffness settings. This capability may be useful for the modulating prosthesis energy return to better mimic human ankle function. Subjective feedback indicated clear perception by the subjects of contrasts among the stiffness settings, including interpretation of scenarios for which different settings may be beneficial. Future applications of the VSF include adapting stiffness to optimize stairs, ramps, turns, and standing.
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Bai X, Ewins D, Crocombe AD, Xu W. A biomechanical assessment of hydraulic ankle-foot devices with and without micro-processor control during slope ambulation in trans-femoral amputees. PLoS One 2018; 13:e0205093. [PMID: 30289921 PMCID: PMC6173401 DOI: 10.1371/journal.pone.0205093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Slope ambulation is a challenge for trans-femoral amputees due to a relative lack of knee function. The assessment of prosthetic ankles on slopes is required for supporting the design, optimisation, and selection of prostheses. This study assessed two hydraulic ankle-foot devices (one of the hydraulic ankles is controlled by a micro-processor that allows real-time adjustment in ankle resistance and range of motion) used by trans-femoral amputees in ascending and descending a 5-degree slope walking, against a rigid ankle-foot device. Five experienced and active unilateral trans-femoral amputees performed ascending and descending slope tests with their usual prosthetic knee and socket fitted with a rigid ankle-foot, a hydraulic ankle-foot without a micro-processor, and a hydraulic ankle-foot with a micro-processor optimised for ascending and descending slopes. Peak values in hip, knee and ankle joint angles and moments were collected and the normalcy Trend Symmetry Index of the prosthetic ankle moments (as an indication of bio-mimicry) were calculated and assessment. Particular benefits of the hydraulic ankle-foot devices were better bio-mimicry of ankle resistance moment, greater range of motion, and improved passive prosthetic knee stability according to the greater mid-stance external knee extensor moment (especially in descending slope) compared to the rigid design. The micro-processor controlled device demonstrated optimised ankle angle and moment patterns for ascending and descending slope respectively, and was found to potentially further improve the ankle moment bio-minicry and prosthetic knee stability compared to the hydraulic device without a micro-processor. However the difference between the micro-processor controlled device and the one without a micro-processor does not reach a statistically significant level.
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Affiliation(s)
- Xuefei Bai
- National Research Center for Rehabilitation Technical Aids, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing, China
| | - David Ewins
- Department of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
- Gait Laboratory, Queen Mary’s Hospital, Roehampton, London, United Kingdom
| | - Andrew David Crocombe
- Department of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
| | - Wei Xu
- Department of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
- * E-mail:
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Gharini M, Mohammadi Moghaddam M, Farahmand F. Personalized design of ankle-foot prosthesis based on computer modeling of amputee locomotion. Assist Technol 2018; 32:100-108. [PMID: 29944462 DOI: 10.1080/10400435.2018.1493708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This study proposes a computer modeling approach to find the optimal damping coefficients of the viscoelastic ankle-foot prostheses for each specific amputee. A two-dimensional locomotion model was developed for a transtibial amputee and personalized using his body measures and the reference gait pattern of an equivalent able-bodied subject. By employing the forward dynamic simulation, the amputee's locomotion was synthesized for different prosthetic settings to find the optimal damping coefficients, based on a kinematics and a total work cost function. Results indicated a good agreement between the model predictions and the experimental observations.
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Affiliation(s)
- Mohammad Gharini
- Department of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | | | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Zelik KE, Honert EC. Ankle and foot power in gait analysis: Implications for science, technology and clinical assessment. J Biomech 2018; 75:1-12. [PMID: 29724536 PMCID: PMC6005760 DOI: 10.1016/j.jbiomech.2018.04.017] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
In human gait analysis studies, the entire foot is typically modeled as a single rigid-body segment; however, this neglects power generated/absorbed within the foot. Here we show how treating the entire foot as a rigid body can lead to misunderstandings related to (biological and prosthetic) foot function, and distort our understanding of ankle and muscle-tendon dynamics. We overview various (unconventional) inverse dynamics methods for estimating foot power, partitioning ankle vs. foot contributions, and computing combined anklefoot power. We present two case study examples. The first exemplifies how modeling the foot as a single rigid-body segment causes us to overestimate (and overvalue) muscle-tendon power generated about the biological ankle (in this study by up to 77%), and to misestimate (and misinform on) foot contributions; corroborating findings from previous multi-segment foot modeling studies. The second case study involved an individual with transtibial amputation walking on 8 different prosthetic feet. The results exemplify how assuming a rigid foot can skew comparisons between biological and prosthetic limbs, and lead to incorrect conclusions when comparing different prostheses/interventions. Based on analytical derivations, empirical findings and prior literature we recommend against computing conventional ankle power (between shank-foot). Instead, we recommend using an alternative estimate of power generated about the ankle joint complex (between shank-calcaneus) in conjunction with an estimate of foot power (between calcaneus-ground); or using a combined anklefoot power calculation. We conclude that treating the entire foot as a rigid-body segment is often inappropriate and ill-advised. Including foot power in biomechanical gait analysis is necessary to enhance scientific conclusions, clinical evaluations and technology development.
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Affiliation(s)
- Karl E Zelik
- Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA; Dept. of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Dept. of Physical Medicine & Rehabilitation, Vanderbilt University, Nashville, TN, USA.
| | - Eric C Honert
- Dept. of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Ernst M, Altenburg B, Bellmann M, Schmalz T. Standing on slopes - how current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task. J Neuroeng Rehabil 2017; 14:117. [PMID: 29145876 PMCID: PMC5691831 DOI: 10.1186/s12984-017-0322-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. METHODS Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. RESULTS Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. CONCLUSIONS A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.
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Affiliation(s)
- Michael Ernst
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
| | - Björn Altenburg
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
| | - Malte Bellmann
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
| | - Thomas Schmalz
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
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Safaeepour Z, Eshraghi A, Geil M. The effect of damping in prosthetic ankle and knee joints on the biomechanical outcomes: A literature review. Prosthet Orthot Int 2017; 41:336-344. [PMID: 27940898 DOI: 10.1177/0309364616677651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Given the growing number of variable-damping prosthetic knee and ankle components and broad number of potential biomechanical outcomes, a systematic review is needed to assess advantages of damped knee and ankle units over non-damped prostheses. OBJECTIVES This study provides an overview of the biomechanical outcomes associated with the use of prosthetic knees and ankles with damping mechanisms in individuals with lower limb amputation. STUDY DESIGN Literature review. METHODS A systematic search was performed through PubMed, Science Direct, Web of Science, Cochrane, and Scopus databases from June 1994 to March 2016. The level of evidence of each article was assessed using a 13-element checklist for evaluating non-randomized controlled trials for quality assessment. Afterward, the studies were classified as A-level, B-level, or C-level based on total score and positive scores from certain key categories. RESULTS In total, 22 papers remained for the quality assessment based on the inclusion criteria. In total, 15 studies scored sufficiently high quality scores to be classified. One article scored as A-level, eight as B-level, and six as C-level. In total, 10 studied knees and 5 examined ankles. Sample sizes ranged from 5 to 28 subjects. CONCLUSION Available studies were evaluated in detail and biomechanical outcomes were extracted from the studies that met criteria. Results of this review indicate that study methodology and outcome measures were heterogeneous across reviewed papers. This could be an explanation for inconsistent findings of the reviewed studies. Only self-selected gait speed showed a consistent difference when dampers were applied to the leg. Thus, further research is required in this area. Clinical relevance This study provides an overview of evidence related to prosthetic knee and foot/ankle components with damping attachments. Research related to biomechanical outcomes is of great importance for researchers and practitioners in this area. The studies drew mixed conclusions, but walking speed was consistently different for damped versus non-damped components.
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Affiliation(s)
- Zahra Safaeepour
- 1 Biomechanics Laboratory, Georgia State University, Atlanta, GA, USA.,2 Department of Prosthetics and Orthotics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arezoo Eshraghi
- 3 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Mark Geil
- 1 Biomechanics Laboratory, Georgia State University, Atlanta, GA, USA
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Robotics in Lower-Limb Rehabilitation after Stroke. Behav Neurol 2017; 2017:3731802. [PMID: 28659660 PMCID: PMC5480018 DOI: 10.1155/2017/3731802] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 12/02/2022] Open
Abstract
With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, training paradigm, and control strategy of the lower-limb rehabilitation robots in the reviewed literature. A brief review on the gait detection technology of lower-limb rehabilitation robots is also presented. Finally, we discuss the future directions of the lower-limb rehabilitation robots.
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Weinert-Aplin R, Howard D, Twiste M, Jarvis H, Bennett A, Baker R. Energy flow analysis of amputee walking shows a proximally-directed transfer of energy in intact limbs, compared to a distally-directed transfer in prosthetic limbs at push-off. Med Eng Phys 2017; 39:73-82. [DOI: 10.1016/j.medengphy.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/29/2016] [Accepted: 10/23/2016] [Indexed: 11/17/2022]
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Struchkov V, Buckley JG. Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle-foot mechanisms. Clin Biomech (Bristol, Avon) 2016; 32:164-70. [PMID: 26689894 DOI: 10.1016/j.clinbiomech.2015.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking down slopes and/or over uneven terrain is problematic for unilateral trans-tibial amputees. Accordingly, 'ankle' devices have been added to some dynamic-response feet. This study determined whether use of a microprocessor controlled passive-articulating hydraulic ankle-foot device improved the gait biomechanics of ramp descent in comparison to conventional ankle-foot mechanisms. METHODS Nine active unilateral trans-tibial amputees repeatedly walked down a 5° ramp, using a hydraulic ankle-foot with microprocessor active or inactive or using a comparable foot with rubber ball-joint (elastic) 'ankle' device. When inactive the hydraulic unit's resistances were those deemed to be optimum for level-ground walking, and when active, the plantar- and dorsi-flexion resistances switched to a ramp-descent mode. Residual limb kinematics, joints moments/powers and prosthetic foot power absorption/return were compared across ankle types using ANOVA. FINDINGS Foot-flat was attained fastest with the elastic foot and second fastest with the active hydraulic foot (P<0.001). Prosthetic shank single-support mean rotation velocity (p =0.006), and the flexion (P<0.001) and negative work done at the residual knee (P=0.08) were reduced, and negative work done by the ankle-foot increased (P<0.001) when using the active hydraulic compared to the other two ankle types. INTERPRETATION The greater negative 'ankle' work done when using the active hydraulic compared to other two ankle types, explains why there was a corresponding reduction in flexion and negative work at the residual knee. These findings suggest that use of a microprocessor controlled hydraulic foot will reduce the biomechanical compensations used to walk down slopes.
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Affiliation(s)
- Vasily Struchkov
- Division of Medical Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK
| | - John G Buckley
- Division of Medical Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK.
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