Avoiding obstacles poses a significant challenge for amputees using mechanically-passive transfemoral prosthetic limbs due to their lack of direct knee control. In contrast, powered prostheses can potentially improve obstacle avoidance via their ability to add energy to the system. In past work, researchers have proposed stumble recovery systems for powered prosthetic limbs that provide assistance in the event of a trip. However, these systems only aid recovery after an obstacle has disrupted the user's gait and do not proactively help the amputee avoid obstacles. To address this problem, we designed an adaptive system that learns online to use kinematic data from the prosthetic limb to detect the user's obstacle avoidance intent in early swing. When the system detects an obstacle, it alters the planned swing trajectory to help avoid trips. Additionally, the system uses a regression model to predict the required knee flexion angle for the trip response. We validated the system by comparing obstacle avoidance success rates with and without the obstacle avoidance system. For a non-amputee subject wearing the prosthesis through an adapter, the trip avoidance system improved the obstacle negotiation success rate from 37% to 89%, while an amputee subject improved his success rate from 35% to 71% when compared to utilizing minimum jerk trajectories for the knee and ankle joints.
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Factors leading to falls in transfemoral prosthesis users: a case series of sound-side stumble recovery responses
Transfemoral prosthesis users’ high fall rate is related to increased injury risk, medical costs, and fear of falling. Better understanding how stumble conditions (e.g., participant age, prosthesis type, side tripped, and swing phase of perturbation) affect transfemoral prosthesis users could provide insight into response deficiencies and inform fall prevention interventions.
Six unilateral transfemoral prosthesis users experienced obstacle perturbations to their sound limb in early, mid, and late swing phase. Fall outcome, recovery strategy, and kinematics of each response were recorded to characterize (1) recoveries versus falls for transfemoral prosthesis users and (2) prosthesis user recoveries versus healthy adult recoveries.
Out of 26 stumbles, 15 resulted in falls with five of six transfemoral prosthesis users falling at least once. By contrast, in a previously published study of seven healthy adults comprising 214 stumbles using the same experimental apparatus, no participants fell. The two oldest prosthesis users fell after every stumble, stumbles in mid swing resulted in the most falls, and prosthesis type was not related to strategy/fall outcomes. Prosthesis users who recovered used the elevating strategy in early swing, lowering strategy in late swing, and elevating or lowering/delayed lowering with hopping in mid swing, but exhibited increased contralateral (prosthetic-side) thigh abduction and trunk flexion relative to healthy controls. Falls occurred if the tripped (sound) limb did not reach ample thigh/knee flexion to sufficiently clear the obstacle in the elevating step, or if the prosthetic limb did not facilitate a successful step response after the initial sound-side elevating or lowering step. Such responses generally led to smaller step lengths, less anterior foot positioning, and more forward trunk flexion/flexion velocity in the resulting foot-strikes.
Introducing training (e.g., muscle strength or task-specific motor skill) and/or modifying assistive devices (e.g., lower-limb prostheses or exoskeletons) may improve responses for transfemoral prosthesis users. Specifically, training or exoskeleton assistance could help facilitate sufficient thigh/knee flexion for elevating; training or prosthesis assistance could provide support-limb counteracting torques to aid in elevating; and training or prosthesis assistance could help initiate and safely complete prosthetic swing.
- NSF-PAR ID:
- 10372097
- Publisher / Repository:
- Springer Science + Business Media
- Date Published:
- Journal Name:
- Journal of NeuroEngineering and Rehabilitation
- Volume:
- 19
- Issue:
- 1
- ISSN:
- 1743-0003
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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