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Abstract There is significant need for low-cost, high-performance prosthetic knees in low- and middle-income countries (LMICs) due to a large number of amputees and particularly challenging socioeconomic and environmental conditions. Prostheses are important for maintaining one’s participation in society, culture, and the economy, but many are either prohibitively expensive or do not provide near-able-bodied kinematics. Poor performing prosthetic knees cause discomfort and draw unwanted attention to transfemoral amputees. In this study, we refine the design of a high-performing, single-axis, passive prosthetic knee developed with a focus on the Indian market in order to reduce cost, weight, and part count; enhance manufacturability; and improve aesthetics. The load paths and functional componentry were critically analyzed to identify opportunities to streamline the design while maintaining strength and the near-able-bodied kinematics offered by the original design. The part count was reduced almost four-fold, and the mass of the prosthesis was reduced three-fold. An enclosure was also designed to encase the functional componentry in an aesthetically acceptable package. The changes made to the design are believed to significantly advance the usability and commercial viability of the prosthetic knee. This study may serve as an example of how products developed for emerging markets may achieve affordability without sacrificing performance. 

Abstract Advances in understanding the effects the mechanical characteristics of prosthetic feet on user biomechanics have enabled passive prostheses to improve the walking pattern of people with lower limb amputation. However, there is no consensus on the design methodology and criteria required to maximize specific user outcomes and fully restore their mobility. The Lower Leg Trajectory Error (LLTE) framework is a novel design methodology based on the replication of lower leg dynamics. The LLTE value evaluates how closely a prosthetic foot replicates a target walking pattern. Designing a prosthesis that minimizes the LLTE value, optimizes its mechanical function to enable users to best replicate the target lower leg trajectory. Here, we conducted a systematic sensitivity investigation of LLTE-optimized prostheses. Five people with unilateral transtibial amputation walked overground at self-selected speeds using five prototype energy storage and return feet with varying LLTE values. The prototypes' LLTE values were varied by changing the stiffness of the participant's LLTE-optimized design by 60%, 80%, 120%, and 167%. Users most closely replicated the target able-bodied walking pattern with the LLTE-optimized stiffness, experimentally demonstrating that the predicted optimum was a true optimum. Additionally, the predicted LLTE values were correlated to the user's ability to replicate the target walking pattern, user preferences, and clinical outcomes including roll-over geometries, trunk sway, prosthetic energy return, and peak push-off power. This study further validates the use of the LLTE framework as a predictive and quantitative tool for designing and evaluating prosthetic feet. 

Abstract The walking pattern and comfort of a person with lower limb amputation are determined by the prosthetic foot’s diverse set of mechanical characteristics. However, most design methodologies are iterative and focus on individual parameters, preventing a holistic design of prosthetic feet for a user’s body size and walking preferences. Here we refined and evaluated the lower leg trajectory error (LLTE) framework, a novel quantitative and predictive design methodology that optimizes the mechanical function of a user’s prosthesis to encourage gait dynamics that match their body size and desired walking pattern. Five people with unilateral below-knee amputation walked over-ground at self-selected speeds using an LLTE-optimized foot made of Nylon 6/6, their daily-use foot, and a standardized commercial energy storage and return (ESR) foot. Using the LLTE feet, target able-bodied kinematics and kinetics were replicated to within 5.2% and 13.9%, respectively, 13.5% closer than with the commercial ESR foot. Additionally, energy return and center of mass propulsion work were 46% and 34% greater compared to the other two prostheses, which could lead to reduced walking effort. Similarly, peak limb loading and flexion moment on the intact leg were reduced by an average of 13.1%, lowering risk of long-term injuries. LLTE-feet were preferred over the commercial ESR foot across all users and preferred over the daily-use feet by two participants. These results suggest that the LLTE framework could be used to design customized, high performance ESR prostheses using low-cost Nylon 6/6 material. More studies with large sample size are warranted for further verification. 

Abstract While many studies have attempted to characterize the mechanical behavior of passive prosthetic feet to understand their influence on amputee gait, the relationship between mechanical design and biomechanical performance has not yet been fully articulated from a fundamental physics perspective. A novel framework, called lower leg trajectory error (LLTE) framework, presents a means of quantitatively optimizing the constitutive model of prosthetic feet to match a reference kinematic and kinetic dataset. This framework can be used to predict the required stiffness and geometry of a prosthesis to yield a desired biomechanical response. A passive prototype foot with adjustable ankle stiffness was tested by a unilateral transtibial amputee to evaluate this framework. The foot condition with LLTE-optimal ankle stiffness enabled the user to replicate the physiological target dataset within 16% root-mean-square (RMS) error. Specifically, the measured kinematic variables matched the target kinematics within 4% RMS error. Testing a range of ankle stiffness conditions from 1.5 to 24.4 N·m/deg with the same user indicated that conditions with lower LLTE values deviated the least from the target kinematic data. Across all conditions, the framework predicted the horizontal/vertical position, and angular orientation of the lower leg during midstance within 1.0 cm, 0.3 cm, and 1.5 deg, respectively. This initial testing suggests that prosthetic feet designed with low LLTE values could offer benefits to users. The LLTE framework is agnostic to specific foot designs and kinematic/kinetic user targets, and could be used to design and customize prosthetic feet. 

Abstract Many Holocene hydroclimate records show rainfall changes that vary with local orbital insolation. However, some tropical regions display rainfall evolution that differs from gradual precessional pacing, suggesting that direct rainfall forcing effects were predominantly driven by sea-surface temperature thresholds or inter-ocean temperature gradients. Here we present a 12,000 yr continuous U/Th-dated precipitation record from a Guatemalan speleothem showing that Central American rainfall increased within a 2000 yr period from a persistently dry state to an active convective regime at 9000 yr BP and has remained strong thereafter. Our data suggest that the Holocene evolution of Central American rainfall was driven by exceeding a temperature threshold in the nearby tropical oceans. The sensitivity of this region to slow changes in radiative forcing is thus strongly mediated by internal dynamics acting on much faster time scales.