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Abstract Background After above-knee amputation, the missing biological knee and ankle are replaced with passive prosthetic devices. Passive prostheses are able to dissipate limited amounts of energy using resistive damper systems during “negative energy” tasks like sit-down. However, passive prosthetic knees are not able to provide high levels of resistance at the end of the sit-down movement when the knee is flexed, and users need the most support. Consequently, users are forced to over-compensate with their upper body, residual hip, and intact leg, and/or sit down with a ballistic and uncontrolled movement. Powered prostheses have the potential to solve this problem. Powered prosthetic joints are controlled by motors, which can produce higher levels of resistance at a larger range of joint positions than passive damper systems. Therefore, powered prostheses have the potential to make sitting down more controlled and less difficult for above-knee amputees, improving their functional mobility. Methods Ten individuals with above-knee amputations sat down using their prescribed passive prosthesis and a research powered knee-ankle prosthesis. Subjects performed three sit-downs with each prosthesis while we recorded joint angles, forces, and muscle activity from the intact quadricep muscle. Our main outcome measures were weight-bearing symmetry and muscle effort of the intact quadricep muscle. We performed paired t-tests on these outcome measures to test for significant differences between passive and powered prostheses. Results We found that the average weight-bearing symmetry improved by 42.1% when subjects sat down with the powered prosthesis compared to their passive prostheses. This difference was significant (p = 0.0012), and every subject’s weight-bearing symmetry improved when using the powered prosthesis. Although the intact quadricep muscle contraction differed in shape, neither the integral nor the peak of the signal was significantly different between conditions (integral p > 0.01, peak p > 0.01). Conclusions In this study, we found that a powered knee-ankle prosthesis significantly improved weight-bearing symmetry during sit-down compared to passive prostheses. However, we did not observe a corresponding decrease in intact-limb muscle effort. These results indicate that powered prosthetic devices have the potential to improve balance during sit-down for individuals with above-knee amputation and provide insight for future development of powered prosthetics.
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The motor and the brake of the trailing leg in human walking: transtibial amputation limits ankle–knee torque covariation
Lower-limb amputation limits inherent motor abundance in the locomotor system and impairs walking mechanics. Able- bodied walkers vary ankle torque to adjust step-to-step leg force production as measured by resultant ground reaction forces. Simultaneously, knee torque covaries with ankle torque to act as a brake, resulting in consistent peak leg power output meas- ured by external mechanical power generated on the center of mass. Our objective was to test how leg force control during gait is affected by joint torque variance structure in the amputated limb. Within the framework of the uncontrolled manifold analysis, we measured the Index of Motor Abundance (IMA) to quantify joint torque variance structure of amputated legs and its effect on leg force, where IMA>0 indicates a stabilizing structure. We further evaluated the extent to which IMA in amputated legs used individual (INV) and coordinated (COV) joint control strategies. Amputated legs produced IMA and INV values similar to intact legs, indicating that torque deviations of the prosthetic ankle can modulate leg force at the end of stance phase. However, we observed much lower COV values in the amputated leg relative to intact legs indicating that biological knee joint torque of the amputated leg does not covary with prosthetic ankle torque. This observation sug- gests inter-joint coordination during gait is significantly limited as a result of transtibial amputation and may help explain the higher rate of falls and impaired balance recovery in this population, pointing to a greater need to focus on inter-joint coordination within the amputated limb.
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- Award ID(s):
- 1734416
- PAR ID:
- 10481851
- Publisher / Repository:
- Springer
- Date Published:
- Journal Name:
- Experimental Brain Research
- Volume:
- 241
- Issue:
- 1
- ISSN:
- 0014-4819
- Page Range / eLocation ID:
- 161 to 174
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1007/s00221-022-06513-5
