Stair ascent kinematics and kinetics with a powered lower leg system following transtibial amputation

Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.
Gait & posture (Impact Factor: 2.58). 05/2012; 36(2):291-5. DOI: 10.1016/j.gaitpost.2012.03.013
Source: PubMed

ABSTRACT During stair ascent (STA) persons with transtibial amputation (TTA) typically adopt a hip strategy to compensate for the limited ankle motion and joint power that is characteristic of conventional energy storing and returning (ESR) prosthetic feet. The purpose of this investigation was to determine if providing ankle power via a powered prosthetic device (BiOM) normalized STA kinematics and kinetics. Eleven individuals with TTA participated in two STA gait analysis sessions: (1) using an ESR foot, and (2) using the BiOM. Eleven height and weight matched able-bodied controls (CONT) were also assessed. Lower extremity peak kinematic and kinetic values were calculated at a self-selected and controlled cadence (80 steps/min). Increased prosthetic limb peak ankle plantarflexion and push-up power were observed while using the BiOM as compared to ESR. Peak ankle power was not significantly different between BiOM and CONT indicating normalization of ankle power generation. However, peak ankle plantarflexion was significantly lower than CONT. Limb asymmetries including greater prosthetic limb hip flexion and power during stance, and decreased prosthetic limb knee power during stance were observed in the BiOM and ESR conditions. The results suggest that the BiOM successfully increased ankle motion and restored ankle power during STA. These differences did not, however, reduce the use of a hip strategy while ascending stairs. Additional device specific training may be necessary to utilize the full benefits of the device.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Human upright locomotion emerged about 6 million years ago. It is achieved by a complex interaction of the biological infrastructure and the neural control. Bones, muscles, tendons, central nervous commands and reflex mechanisms interact to provide robust and efficient bipedal movement patterns like walking or running. Next to these locomotion tasks humans can also perform complex movements like climbing, dancing or jumping. Diseases or traumatic events may cause the loss of parts of the biological infrastructure or the ability to control the lower limbs. Thus an identification of the required framework helps to improve on the artificial lower limb design and the control for bipedal robots, exoskeletons, orthoses or prostheses. A first artificial leg design was reported about 5000 years ago. After losing one leg in a battle an iron leg was fitted to Queen Vishpla to get her back on the battlefield. Since this time major changes in the structure, the material and the functionality led to improved prosthetic restoration of physically disabled. The characteristics of the biological leg structure are imitated by technical components. Using carbon fiber for the design of prosthetic feet made it possible to benefit from the elastic recoil like in the Achilles tendon in stance phase. Dampers in prosthetic knee joints are able to mimic eccentric muscle work during the gait cycle. Clutch-like mechanisms are used to lock the knee during stance. Such a function is comparable to isometric muscle work. Semiactive knee joints allow changes in damping ratio to adapt the mechanical joint properties to the requirements. Using integrated force or inertial sensors, movement tasks can be identified. An adaptation of damping to different walking speeds and conditions, such as walking inclines, declines, or climbing stairs is possible. All these developments permitted that amputees gait got closer to the natural human gait pattern. However, until the end of the 20th century prostheses were not able to reproduce concentric muscle work. External positive energy is required to compensate for energy losses during locomotion. For climbing stairs or walking inclines not only the ankle, but also the knee joint contributes net positive work to lift the body center of mass. To achieve desired joint motion, a power source like a motor would be required that can inject energy to mimic the concentric function of the muscle fascicles. The thesis comprises an analysis of joint requirements, it evaluates the current prosthetic design approaches and develops models on artificial muscles to mimic lower limb biomechanics in walking and running. The developed models are biologically inspired, while motors represent the function of muscle fibers and springs represent the function of the tendons. These systems are optimized for criteria like minimum joint peak power or minimum required energy for the power source (motor). Results demonstrate that elastic elements can highly decrease the actuator requirements. The springs are able to store energy in one phase of the gait cycle and to release it later when high peak power is required. Without the elastic assistance the reproduction of human joint behavior is hardly possible using current motor technology. The optimized interaction of motor and elasticity is evaluated in walking and running, using a prototype of a powered ankle prosthesis (Walk-Run ankle, Springactive). Next to experiments with a nonamputee, where the prosthesis was fitted in parallel to the fixed healthy ankle joint (Bypass), also experiments with a female unilateral transtibial amputee were performed. The optimized model behavior was compared to experimental observations and showed good agreement. Furthrmore, a concept on the improvement of an optimized walking motor pattern was successfully tested. By smoothening the motor curve to the main characteristics (low-pass filter) it was possible to increase the mechanical work output, to improve the system efficiency, and to decrease the electrical energy consumption and the noise. To further improve the prosthetic performance, the push off timing and the causes for prosthesis noise should be analyzed. Weight reductions and psychoacoustic analysis can additionally help to improve on the amputees acceptance. In addition it must be evaluated how training can effect amputees gait patterns when using powered prostheses. To further reduce the power and the energy requirements, an improvement on the powered prosthesis efficiency is recommended. The efficiency can be further increased by using higher efficiency parts and improving the interaction of the prosthesis and the amputee. The human - machine interaction depends on the prosthesis mechanics and the control algorithm. Similar to the human biarticular muscles, couplings from biological to artificial joints may provide additional benefits for the amputee. The muscles from existing proximal joints would be able to transfer energy to the distal artificial joints. Also the inverse of this principle would be possible. A coupling between the hip and the knee (transfemoral amputees) and between the knee and the ankle (transfemoral and transtibial amputees) would be possible. Due to geometrical constraints, the elemental locomotion control might improve. The results of the thesis, on the efficient cooperation of motors and springs, can be used to improve the design and the control of powered lower limb prostheses. Similar technologies can be used to improve on exoskeleton design to assist elderly and subjects with mobility impairments. Elastic exoskeletons may also augment human performance in daily life or workers environments. Next to assisting the human movement, the elastic actuators may advance the gait performance, the gait robustness, and the operation time of bipedal robots. Thus the results of the thesis Powered Lower Limb Prostheses are not limited to the specific field of prosthetics but may also be useful for applications like exoskeletons and legged robots.
    02/2015, Degree: Phd, Supervisor: André Seyfarth, Thomas Sugar
  • [Show abstract] [Hide abstract]
    ABSTRACT: Individuals with a unilateral transtibial amputation have a greater risk of falling compared to able-bodied individuals, and falling on stairs can lead to serious injuries. Individuals with transtibial amputations have lost ankle plantarflexor muscle function, which is critical for regulating whole-body angular momentum to maintain dynamic balance. Recently, powered prostheses have been designed to provide active ankle power generation with the goal of restoring biological ankle function. However, the effects of using a powered prosthesis on the regulation of whole-body angular momentum are unknown. The purpose of this study was to use angular momentum to evaluate dynamic balance in individuals with a transtibial amputation using powered and passive prostheses relative to able-bodied individuals during stair ascent and descent. Ground reaction forces, external moment arms, and joint powers were also investigated to interpret the angular momentum results. A key result was that individuals with an amputation had a larger range of sagittal-plane angular momentum during prosthetic limb stance compared to able-bodied individuals during stair ascent. There were no significant differences in the frontal, transverse, or sagittal-plane ranges of angular momentum or maximum magnitude of the angular momentum vector between the passive and powered prostheses during stair ascent or descent. These results indicate that individuals with an amputation have altered angular momentum trajectories during stair walking compared to able-bodied individuals, which may contribute to an increased fall risk. The results also suggest that a powered prosthesis provides no distinct advantage over a passive prosthesis in maintaining dynamic balance during stair walking.
    Journal of Biomechanics 08/2014; 47(13). DOI:10.1016/j.jbiomech.2014.08.001 · 2.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: External load at the tibia during activities of daily living provides baseline measures for the improvement of the design of the bone–implant interface for relevant internal and external prostheses. A motion analysis system was used together with an established protocol with skin markers to estimate three-dimensional forces and moments acting on ten equidistant points along the tibial shaft. Twenty young and able-bodied volunteers were analysed while performing three repetitions of the following tasks: level walking at three different speeds, in a straight-line and with sudden changes of direction to the right and to the left, stair ascending and descending, squatting, rising from a chair and sitting down. Moment and force patterns were normalised to the percentage of body weight per height and body weight, respectively, and then averaged over all subjects for each point, about the three tibial anatomical axes, and for each task. Load patterns were found to be consistent over subjects, but different among the anatomical axes, tasks and points. Generally, moments were higher in the medio/lateral axis and influenced by walking speed. In all five walking tasks and in ascending stairs with alternating feet, the more proximal the point was the smaller the mean moment was. For the remaining tasks the opposite trend was observed. The overall largest value was observed in the medio/lateral direction at the ankle centre in level walking at high speed (9.1% body weight * height on average), nearly three times larger than that of the anterior/posterior axis (2.9) during level walking with a sidestep turn. The present results should be of value also for in-vitro mechanical tests and finite element models.
    Journal of Biomechanics 03/2014; 47(5):2014. DOI:10.1016/j.jbiomech.2014.01.045 · 2.66 Impact Factor