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Choosing appropriate prosthetic ankle work to reduce the metabolic cost of individuals with transtibial amputation.

ABSTRACT: Powered ankle prostheses have been designed to reduce the energetic burden that individuals with transtibial amputation experience during ambulation. There is an open question regarding how much power the prosthesis should provide, and whether approximating biological ankle kinetics is optimal to reduce the metabolic cost of users. We tested 10 individuals with transtibial amputation walking on a treadmill wearing the BiOM powered ankle prosthesis programmed with 6 different power settings (0-100%), including a prosthetist-chosen setting, chosen to approximate biological ankle kinetics. We measured subjects' metabolic cost of transport (COT) and the BiOM's net ankle work during each condition. Across participants, power settings greater than 50% resulted in lower COT than 0% or 25%. The relationship between power setting, COT, and net ankle work varied considerably between subjects, possibly due to individual adaptation and exploitation of the BiOM's reflexive controller. For all subjects, the best tested power setting was higher than the prosthetist-chosen setting, resulting in a statistically significant and meaningful difference in COT between the best tested and prosthetist-chosen power settings. The results of this study demonstrate that individuals with transtibial amputation may benefit from prescribed prosthetic ankle push-off work that exceeds biological norms.

SUBMITTER: Ingraham KA

PROVIDER: S-EPMC6193045 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Choosing appropriate prosthetic ankle work to reduce the metabolic cost of individuals with transtibial amputation.

Ingraham Kimberly A KA Choi Hwan H Gardinier Emily S ES Remy C David CD Gates Deanna H DH

Scientific reports 20181017 1

Powered ankle prostheses have been designed to reduce the energetic burden that individuals with transtibial amputation experience during ambulation. There is an open question regarding how much power the prosthesis should provide, and whether approximating biological ankle kinetics is optimal to reduce the metabolic cost of users. We tested 10 individuals with transtibial amputation walking on a treadmill wearing the BiOM powered ankle prosthesis programmed with 6 different power settings (0-10 ...[more]

PMID: 30333504

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Project description:People with lower limb amputation present greater displacements of their centre of gravity in a static situation than able-bodied individuals, as they depend on visual information to a greater extent, which implies an altered stability pattern. The efficacy of different hardness of plantar support to help maintain stability has not yet been determined. The aim of the present study is to assess stability in people with unilateral transtibial amputation with prosthesis in a static situation with insoles of different degrees of hardness and visual conditions with respect to the able-bodied population. For this purpose, 25 patients with amputation and 25 able-bodied individuals were included in both groups, postural stability was assessed by stabilometry. This assessment was carried out under normal conditions (on the floor of the dynamometric platform with eyes open), and under altered conditions (with the interposition of different materials such as plantar support: rigid and soft insoles and, eyes shut). Three variables were considered to assess stability: length of movement of the barycenter (mm), lateral velocity (mm/sg) and anterior velocity (mm/sg). All of them were analysed with the patient in static on the dynamometric platform. The results showed statistically significant differences between the two groups, (amputees and controls) with less stability in the amputee group (p < 0.05) when analysing the variables of length of movement of the barycenter, lateral velocity and anterior velocity. Amputee patients with open eyes exhibited greater stability than those with closed eyes. The hard insoles improved the stability data in amputees (length of movement of the barycenter and anterior velocity) with respect to the barefoot condition, and the soft insoles showed less stability than the patients with hard insoles, or than the barefoot patients. From the results obtained in this study, we can conclude that the PP-DWST 4 mm rigid insoles improve static stability in people with amputation. However, soft insoles impair stability and are therefore discouraged.

Project description:Contemporary prosthetic feet are generally optimized for either daily or high-level activities. Prosthesis users, therefore, often require multiple prostheses to participate in activities that span a range of mobility. Crossover feet (XF) are designed to increase the range of activities that can be performed with a single prosthesis. However, little evidence exists to guide clinical prescription of XF relative to traditional energy storing feet (ESF). The objective of this study was to assess the effects of XF and ESF on health outcomes in people with transtibial amputation. A randomized crossover study was conducted to assess changes in laboratory-based (endurance, perceived exertion, walking performance) and community-based (step activity and self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction) outcomes. Twenty-seven participants were fit with XF and ESF prostheses with standardized sockets, interfaces, and suspensions. Participants were not blinded to the intervention, and wore each prosthesis for one month while their steps were counted with an activity monitor. After each accommodation period, participants returned for data collection. Endurance and perceived exertion were measured with the Six-Minute Walk Test and Borg-CR100, respectively. Walking performance was measured using an electronic walkway. Self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction were measured with survey instruments. Participants also reported foot preferences upon conclusion of the study. Differences between feet were assessed with a crossover analysis. While using XF, users experienced improvements in most community-based outcomes, including mobility (p = .001), fatigue (p = .001), balance confidence (p = .005), activity restrictions (p = .002), and functional satisfaction (p < .001). Participants also exhibited longer sound side steps in XF compared to ESF (p < .001). Most participants (89%) reported an overall preference for XF; others (11%) reported no preference. Results indicate that XF may be a promising alternative to ESF for people with transtibial amputation who engage in a range of mobility activities.Trial registrationClinicalTrials.gov NCT02440711.

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Choosing appropriate prosthetic ankle work to reduce the metabolic cost of individuals with transtibial amputation.

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Choosing appropriate prosthetic ankle work to reduce the metabolic cost of individuals with transtibial amputation.

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