The influence of powered prostheses on user perspectives, metabolics, and activity: a randomized crossover trial

Background Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how use of a powered prosthesis influences everyday physical activity and mobility. Methods Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants’ metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthesis use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson’s correlations. Results Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed in-lab (p = 0.145) and in daily life (p = 0.226), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium-sized effects for device comparisons. With the powered prosthesis, participants had increased self-reported ambulation (g = 0.682) and decreased frustration (g = 0.506). Conclusions There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription. Trial registration: https://clinicaltrials.gov, #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982

The Influence of Powered Prostheses on User Perspectives, Metabolics and Activity: A Randomized Crossover Trial

Background: Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how powered prosthetic use influences everyday physical activity and mobility.Methods: Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants’ metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthetic use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson’s correlations.Results: Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed (p ≥ 0.145), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium- and large-sized effects for device comparisons. With the powered prosthesis, participants had decreased walking speeds in daily life (g = 0.310), increased self-reported ambulation (g = 0.682), and decreased frustration (g = 0.506). Greater preference for the powered prosthesis was moderately correlated with increased everyday walking speed (r = 0.636, p = 0.090).Conclusions: There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription.Trial registration: https://clinicaltrials.gov, #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982

Accurate Heuristic Terrain Prediction in Powered Lower-Limb Prostheses Using Onboard Sensors

This study describes the development and offline validation of a heuristic algorithm for accurate prediction of ground terrain in a lower limb prosthesis. This method is based on inference of the ground terrain geometry using estimation of prosthetic limb kinematics during gait with a single integrated inertial measurement unit. We asked five subjects with below-knee amputations to traverse level ground, stairs, and ramps using a high-range-of-motion powered prosthesis while internal sensor data were remotely logged. We used these data to develop two terrain prediction algorithms. The first employed a state-of-the-art machine learning approach, while the second was a directly tuned heuristic using thresholds on estimated prosthetic ankle joint translations and ground slope. We compared the performance of these algorithms using resubstitution error for the machine learning algorithm and overall error for the heuristic algorithm. Our optimal machine learning algorithm attained a resubstitution error of $3.4\%$ using 45 features, while our heuristic method attained an overall prediction error of $2.8\%$ using only 5 features derived from estimation of ground slope and horizontal and vertical ankle joint displacement. Compared with pattern recognition, the heuristic performed better on each individual subject, and across both level and non-level strides. These results demonstrate a method for heuristic prediction of ground terrain in a powered prosthesis. The method is more accurate, more interpretable, and less computationally expensive than state-of-the-art machine learning methods, and relies only on integrated prosthesis sensors. Finally, the method provides intuitively tunable thresholds to improve performance for specific walking conditions.

Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study

Background Establishing gait symmetry is a major aim of amputee rehabilitation and may be more attainable with powered prostheses. Though, based on previous work, we postulate that users transfer a previously-learned motor pattern across devices, limiting the functionality of more advanced prostheses. The objective of this study was to preliminarily investigate the effect of increased stance time via visual feedback on amputees’ gait symmetry using powered and passive knee prostheses. Methods Five individuals with transfemoral amputation or knee disarticulation walked at their self-selected speed on a treadmill. Visual feedback was used to promote an increase in the amputated-limb stance time. Individuals were fit with a commercially-available powered prosthesis by a certified prosthetist and practiced walking during a prior visit. The same protocol was completed with a passive knee and powered knee prosthesis on separate days. We used repeated-measures, two-way ANOVA (alpha = 0.05) to test for significant effects of the feedback and device factors. Our main outcome measures were stance time asymmetry, peak anterior-posterior ground reaction forces, and peak anterior propulsion asymmetry. Results Increasing the amputated-limb stance time via visual feedback significantly improved the stance time symmetry (p = 0.012) and peak propulsion symmetry (p = 0.036) of individuals walking with both prostheses. With the powered knee prosthesis, the highest feedback target elicited 36% improvement in stance time symmetry, 22% increase in prosthesis-side peak propulsion, and 47% improvement in peak propulsion symmetry compared to a no feedback condition. The changes with feedback were not different with the passive prosthesis, and the main effects of device/ prosthesis type were not statistically different. However, subject by device interactions were significant, indicating individuals did not respond consistently with each device (e.g. prosthesis-side propulsion remained comparable to or was greater with the powered versus passive prosthesis for different subjects). Overall, prosthesis-side peak propulsion averaged across conditions was 31% greater with the powered prosthesis and peak propulsion asymmetry improved by 48% with the powered prosthesis. Conclusions Increasing prosthesis-side stance time via visual feedback favorably improved individuals’ temporal and propulsive symmetry. The powered prosthesis commonly enabled greater propulsion, but individuals adapted to each device with varying behavior, requiring further investigation.