Shock absorption during transtibial amputee gait: Does longitudinal prosthetic stiffness play a role?

BACKGROUND: Reduced-stiffness components are often prescribed in lower-limb prostheses, but their efficacy in augmenting shock absorption has been inconclusive. OBJECTIVES: To perform a systematic variation of longitudinal prosthetic stiffness over a wide range of values and to evaluate its effect on shock absorption during gait. STUDY DESIGN: Repeated-measures crossover experiment. METHODS: Twelve subjects with a unilateral transtibial amputation walked at normal and fast self-selected speeds. Longitudinal prosthetic stiffness was modified by springs within a shock-absorbing pylon: normal (manufacturer recommended), 75% of normal (medium), 50% of normal (soft), and rigid (displacement blocked). The variables of interest were kinematic (stance-phase knee flexion and pelvic obliquity) and kinetic (prosthetic-side ground reaction force loading peak magnitude and timing). RESULTS: No changes were observed in kinematic measures during gait. A significant difference in peak ground reaction force magnitudes between medium and normal ( p = 0.001) during freely selected walking was attributed to modified walking speed ( p = 0.008). Ground reaction force peaks were found to be statistically different during fast walking, but only between isolated stiffness conditions. Thus, altering longitudinal prosthesis stiffness produced no appreciable change in gait biomechanics. CONCLUSION: Prosthesis stiffness does not appear to substantially influence shock absorption in transtibial prosthesis users. Clinical relevance Varying the level of longitudinal prosthesis stiffness did not meaningfully influence gait biomechanics at self-selected walking speeds. Thus, as currently prescribed within a transtibial prosthesis, adding longitudinal stiffness in isolation may not provide the anticipated shock absorption benefits. Further research into residual limb properties and compensatory mechanisms is needed.

Impact testing of the residual limb: System response to changes in prosthetic stiffness.

Currently, it is unknown whether changing prosthetic limb stiffness affects the total limb stiffness and influences the shock absorption of an individual with transtibial amputation. The hypotheses tested within this study are that a decrease in longitudinal prosthetic stiffness will produce (1) a reduced total limb stiffness, and (2) reduced magnitude of peak impact forces and increased time delay to peak force. Fourteen subjects with a transtibial amputation participated in this study. Prosthetic stiffness was modified by means of a shock-absorbing pylon that provides reduced longitudinal stiffness through compression of a helical spring within the pylon. A sudden loading evaluation device was built to examine changes in limb loading mechanics during a sudden impact event. No significant change was found in the peak force magnitude or timing of the peak force between prosthetic limb stiffness conditions. Total limb stiffness estimates ranged from 14.9 to 17.9 kN/m but were not significantly different between conditions. Thus, the prosthetic-side total limb stiffness was unaffected by changes in prosthetic limb stiffness. The insensitivity of the total limb stiffness to prosthetic stiffness may be explained by the mechanical characteristics (i.e., stiffness and damping) of the anatomical tissue within the residual limb.

A novel in vivo impact device for evaluation of sudden limb loading response.

The lower limbs are subjected to large impact forces on a daily basis during gait, and ambulators rely on various mechanisms to protect the musculoskeletal system from these potentially damaging shocks. However, it is difficult to assess the efficacy of anatomical mechanisms and potential clinical interventions on impact forces because of limitations of the testing environment. The current paper describes a new in vivo measurement device (sudden loading evaluation device, or SLED) designed to address shortcomings of previous loading protocols. To establish the repeatability and validity of this testing device, reliability and human participant data were collected while the stiffnesses of simulated and prosthetic limbs were systematically varied. The peak impact forces delivered by the SLED ranged from 706±3 N to 2157±32 N during reliability testing and from 784±30 N to 938±18 N with the human participant. The relatively low standard deviations indicate good reliability within the impacts delivered by the SLED, while the magnitude of the loads experienced by the human participant (98-117% BW) were comparable to ground reaction forces during level walking. Thus, the SLED may be valuable as a research tool for investigations of lower-limb impact loading events.

Effect of prosthetic gel liner thickness on gait biomechanics and pressure distribution within the transtibial socket.

Prosthetic gel liners are often prescribed for persons with lower-limb amputations to make the prosthetic socket more comfortable. However, their effects on residual limb pressures and gait characteristics have not been thoroughly explored. This study investigated the effects of gel liner thickness on peak socket pressures and gait patterns of persons with unilateral transtibial amputations. Pressure and quantitative gait data were acquired while subjects walked on liners of two different uniform thicknesses. Fibular head peak pressures were reduced (p = 0.04) with the thicker liner by an average of 26 +/- 21%, while the vertical ground reaction force (GRF) loading peak increased 3 +/- 3% (p = 0.02). Most subjects perceived increased comfort within the prosthetic socket with the thicker liner, which may be associated with the reduced fibular head peak pressures. Additionally, while the thicker liner presumably increased comfort by providing a more compliant limb-socket interface, the higher compliance may have reduced force and vibration feedback to the residual limb and contributed to the larger vertical GRF loading peaks. We conclude that determining optimal gel liner thickness for a particular individual will require further investigations to better identify and understand the compromises that occur between user perception, residual-limb pressure distribution, and gait biomechanics.