Continuous relative phases of walking with an articulated passive ankle-foot prosthesis in individuals with a unilateral transfemoral and transtibial amputation: an explorative case-control study.

BACKGROUND: A mechanical ankle-foot prosthesis (Talaris Demonstrator) was developed to improve prosthetic gait in people with a lower-limb amputation. This study aims to evaluate the Talaris Demonstrator (TD) during level walking by mapping coordination patterns based on the sagittal continuous relative phase (CRP). METHODS: Individuals with a unilateral transtibial amputation, transfemoral amputation and able-bodied individuals completed 6 minutes of treadmill walking in consecutive blocks of 2 minutes at self-selected (SS) speed, 75% SS speed and 125% SS speed. Lower extremity kinematics were captured and hip-knee and knee-ankle CRPs were calculated. Statistical non-parametric mapping was applied and statistical significance was set at 0.05. RESULTS: The hip-knee CRP at 75% SS walking speed with the TD was larger in the amputated limb of participants with a transfemoral amputation compared to able-bodied individuals at the beginning and end of the gait cycle (p = 0.009). In people with a transtibial amputation, the knee-ankle CRP at SS and 125% SS walking speeds with the TD were smaller in the amputated limb at the beginning of the gait cycle compared to able-bodied individuals (p = 0.014 and p = 0.014, respectively). Additionally, no significant differences were found between both prostheses. However, visual interpretation indicates a potential advantage of the TD over the individual's current prosthesis. CONCLUSION: This study provides lower-limb coordination patterns in people with a lower-limb amputation and reveals a possible beneficial effect of the TD over the individuals' current prosthesis. Future research should include a well-sampled investigation of the adaptation process combined with the prolonged effects of the TD.

Therapeutic benefits of lower limb prostheses: a systematic review.

BACKGROUND: Enhancing the quality of life of people with a lower limb amputation is critical in prosthetic development and rehabilitation. Yet, no overview is available concerning the impact of passive, quasi-passive and active ankle-foot prostheses on quality of life. OBJECTIVE: To systematically review the therapeutic benefits of performing daily activities with passive, quasi-passive and active ankle-foot prostheses in people with a lower limb amputation. METHODS: We searched the Pubmed, Web of Science, Scopus and Pedro databases, and backward citations until November 3, 2021. Only English-written randomised controlled trials, cross-sectional, cross-over and cohort studies were included when the population comprised individuals with a unilateral transfemoral or transtibial amputation, wearing passive, quasi-passive or active ankle-foot prostheses. The intervention and outcome measures had to include any aspect of quality of life assessed while performing daily activities. We synthesised the participants' characteristics, type of prosthesis, intervention, outcome and main results, and conducted risk of bias assessment using the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021290189. RESULTS: We identified 4281 records and included 34 studies in total. Results indicate that quasi-passive and active prostheses are favoured over passive prostheses based on biomechanical, physiological, performance and subjective measures in the short-term. All studies had a moderate or high risk of bias. CONCLUSION: Compared to passive ankle-foot prostheses, quasi-passive and active prostheses significantly enhance the quality of life. Future research should investigate the long-term therapeutic benefits of prosthetics devices.

Cognitive performance and brain dynamics during walking with a novel bionic foot: A pilot study.

OBJECTIVES: The objectives are to determine neural dynamics during gait using electro-encephalography and source localization, and to investigate the attentional demand during walking in able-bodied individuals, and individuals with an amputation. MATERIALS & METHODS: Six able-bodied individuals conducted one experimental trial, and 6 unilateral transtibial and 6 unilateral transfemoral amputees performed 2 experimental trials; the first with the prosthesis currently used by the subjects and the second with a novel powered transtibial prosthesis, i.e. the Ankle Mimicking Prosthetic foot 4.0. Each experimental trial comprised 2 walking tasks; 6 and 2 minutes treadmill walking at normal speed interspersed by 5 minutes of rest. During 6 minutes walking the Sustained Attention to Response (go-no go) Task, which measures reaction time and accuracy, was performed. Electro-encephalographic data were gathered when subjects walked 2 minutes. Motor-related cortical potentials and brain source activity during gait were examined. Normality and (non-) parametric tests were conducted (p<0.05). RESULTS AND DISCUSSION: In contrast to transtibial amputees, transfemoral amputees required more attentional demands during walking with Ankle Mimicking Prosthetic foot 4.0 compared to the current passive prosthetic device and able-bodied individuals (reaction time and accuracy: p≤0.028). Since risk of falling is associated with altered attentional demands, propulsive forces of the novel device need to be better controlled for transfemoral amputees. No motor-related cortical potentials at Cz were observed in transfemoral amputees walking with the novel prosthesis, whereas motor-related cortical potentials between transtibial amputees and able-bodied individuals during walking at normal speed did not differ. The first positive electro-physiological peak deflection appeared during toe-off phase and showed higher activity within the underlying brain sources in transtibial amputees walking with Ankle Mimicking Prosthetic foot 4.0 compared to able-bodied individuals. The required higher neural input to accomplish the same physical activity compared to able-bodied individuals is possibly due to the limited acclimation period to the novel device and consequently increased afferent sensory feedback for postural control.

ED-FNN: A New Deep Learning Algorithm to Detect Percentage of the Gait Cycle for Powered Prostheses.

Throughout the last decade, a whole new generation of powered transtibial prostheses and exoskeletons has been developed. However, these technologies are limited by a gait phase detection which controls the wearable device as a function of the activities of the wearer. Consequently, gait phase detection is considered to be of great importance, as achieving high detection accuracy will produce a more precise, stable, and safe rehabilitation device. In this paper, we propose a novel gait percent detection algorithm that can predict a full gait cycle discretised within a 1% interval. We called this algorithm an exponentially delayed fully connected neural network (ED-FNN). A dataset was obtained from seven healthy subjects that performed daily walking activities on the flat ground and a 15-degree slope. The signals were taken from only one inertial measurement unit (IMU) attached to the lower shank. The dataset was divided into training and validation datasets for every subject, and the mean square error (MSE) error between the model prediction and the real percentage of the gait was computed. An average MSE of 0.00522 was obtained for every subject in both training and validation sets, and an average MSE of 0.006 for the training set and 0.0116 for the validation set was obtained when combining all subjects' signals together. Although our experiments were conducted in an offline setting, due to the forecasting capabilities of the ED-FNN, our system provides an opportunity to eliminate detection delays for real-time applications.

The efficacy of the Ankle Mimicking Prosthetic Foot prototype 4.0 during walking: Physiological determinants.

BACKGROUND: Evaluating the effectiveness of a novel prosthetic device during walking is an important step in product development. OBJECTIVE: To investigate the efficacy of a novel quasi-passive ankle prosthetic device, Ankle Mimicking Prosthetic Foot 4.0, during walking at different speeds, using physiological determinants in transtibial and transfemoral amputees. STUDY DESIGN: Nonrandomized crossover design for amputees. METHODS: Six able-bodied subjects, six unilateral transtibial amputees, and six unilateral transfemoral amputees underwent a 6-min walk test at normal speed, followed by series of 2-min walking at slow, normal, and fast speeds. The intensity of effort and subjective measures were determined. Amputees performed all walking tests on a treadmill with current and novel prostheses. Shapiro-Wilk normality tests and parametric and nonparametric tests were conducted (p < 0.05). RESULTS: Compared to able-bodied individuals, the rating of perceived exertion levels were significantly elevated in transtibial and transfemoral amputees for both prostheses (p ≤ 0.016). Compared to able-bodied individuals transfemoral amputees also showed significantly elevated heart rate for both prostheses at normal speed (p ≤ 0.043). Within-group comparisons demonstrated that walking with Ankle Mimicking Prosthetic Foot significantly increased the heart rate in transfemoral amputees and transtibial compared to current prosthesis (p = 0.002). Furthermore, transfemoral amputees reached a significantly higher rating of perceived exertion levels. CONCLUSION: Intensity of effort during walking with Ankle Mimicking Prosthetic Foot is higher compared to current prostheses. Clinical relevance Ankle Mimicking Prosthetic Foot 4.0 is a novel quasi-passive ankle prosthesis with state-of-the-art technological parts. Subjective measures show the importance of this technology, but the intensity of effort during walking still remains higher compared to current passive prostheses, especially in transfemoral amputees.

Biarticular elements as a contributor to energy efficiency: biomechanical review and application in bio-inspired robotics.

Despite the increased interest in exoskeleton research in the last decades, not much progress has been made on the successful reduction of user effort. In humans, biarticular elements have been identified as one of the reasons for the energy economy of locomotion. This document gives an extensive literature overview concerning the function of biarticular muscles in human beings. The exact role of these muscles in the efficiency of human locomotion is reduced to three elementary functions: energy transfer towards distal joints, efficient control of output force direction and double joint actuation. This information is used to give an insight in the application of biarticular elements in bio-inspired robotics, i.e. bipedal robots, exoskeletons, robotic manipulators and prostheses. Additionally, an attempt is made to find an answer on the question whether the biarticular property leads to a unique contribution to energy efficiency of locomotion, unachievable by mono-articular alternatives. This knowledge is then further utilised to indicate how biarticular actuation of exoskeletons can contribute to an increased performance in reducing user effort.

The AMP-Foot 3, new generation propulsive prosthetic feet with explosive motion characteristics: design and validation.

The last decades, rehabilitation has become a challenging context for mechatronical engineering. From the state-of-the-art it is seen that the field of prosthetics offers very promising perspectives to roboticist. Today's prosthetic feet tend to improve amputee walking experience by delivering the necessary push-off forces while walking. Therefore, several new types of (compliant) actuators are developed in order to fulfill the torque and power requirements of a sound ankle-foot complex with minimized power consumption. At the Vrije Universiteit Brussel, the Robotics and Multibody Mechanics research group puts a lot of effort in the design and development of new bionic feet. In 2013, the Ankle Mimicking Prosthetic (AMP-) Foot 2, as a proof-of-concept, showed the advantage of using the explosive elastic actuator capable of delivering the full ankle torques ([Formula: see text] Nm) and power ([Formula: see text] W) with only a 60 W motor. In this article, the authors present the AMP-Foot 3, using an improved actuation method and using two locking mechanisms for improved energy storage during walking. The article focusses on the mechanical design of the device and validation of its working principle.

Design and Validation of the Ankle Mimicking Prosthetic (AMP-) Foot 2.0.

Transtibial (TT) amputations, or below-knee amputations, are among the most frequently performed major limb removals. To replace the missing limb, numerous prosthetic devices were developed. A study of the state-of-the-art in TT prostheses shows that none of the commercially available devices are capable of mimicking an able-bodied ankle-foot complex. Still on a research level, some powered prosthetic devices have the potential to improve amputee walking experience, but still need heavy and bulky actuators to provide the necessary power of propulsion. With the AMP-Foot 2.0, the authors propose a new concept for an energy efficient, powered transtibial prosthesis. Its design enables the use of a low power actuator which stores energy in springs during the complete stance phase that can be released at push-off. Thanks to this, the size and weight of the actuator can be decreased considerably while the ankle still provides the full power necessary for forward propulsion. A prototype of the AMP-Foot 2.0 has been built and experiments with a transfemural amputee were conducted. The captured data is presented and analyzed throughout this paper.