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Clinical Orthopaedics and Related Research®

, Volume 472, Issue 10, pp 3044–3054 | Cite as

Does Use of a Powered Ankle-foot Prosthesis Restore Whole-body Angular Momentum During Walking at Different Speeds?

  • Susan D’Andrea
  • Natalie Wilhelm
  • Anne K. Silverman
  • Alena M. Grabowski
Symposium: Recent Advances in Amputation Surgery and Rehabilitation

Abstract

Background

Whole-body angular momentum (H) influences fall risk, is tightly regulated during walking, and is primarily controlled by muscle force generation. People with transtibial amputations using passive-elastic prostheses typically have greater H compared with nonamputees.

Questions/purposes

(1) Do people with unilateral transtibial amputations using passive-elastic prostheses have greater sagittal and frontal plane H ranges of motion during walking compared with nonamputees and compared with using powered prostheses? (2) Does use of powered ankle-foot prostheses result in equivalent H ranges in all planes of motion compared with nonamputees during walking as a result of normative prosthetic ankle power generation?

Methods

Eight patients with a unilateral transtibial amputation and eight nonamputees walked 0.75, 1.00, 1.25, 1.50, and 1.75 m/s while we measured kinematics and ground reaction forces. We calculated H for participants using their passive-elastic prosthesis and a powered ankle-foot prosthesis and for nonamputees at each speed.

Results

Patients using passive-elastic prostheses had 32% to 59% greater sagittal H ranges during the affected leg stance phase compared with nonamputees at 1.00 to 1.75 m/s (p < 0.05). Patients using passive-elastic prostheses had 5% and 9% greater sagittal H ranges compared with using powered prostheses at 1.25 and 1.50 m/s, respectively (p < 0.05). Participants using passive-elastic prostheses had 29% and 17% greater frontal H ranges at 0.75 and 1.50 m/s, respectively, compared with nonamputees (p < 0.05). Surprisingly, patients using powered prostheses had 26% to 50% greater sagittal H ranges during the affected leg stance phase compared with nonamputees at 1.00 to 1.75 m/s (p < 0.05). Patients using powered prostheses also had 26% greater frontal H range compared with nonamputees at 0.75 m/s (p < 0.05).

Conclusions

People with a transtibial amputation may more effectively regulate H at two specific walking speeds when using powered compared with passive-elastic prostheses.

Clinical Relevance

Our results support the hypothesis that an ankle-foot prosthesis capable of providing net positive work during the stance phase of walking reduces sagittal plane H; future studies are needed to validate our biomechanical findings with larger numbers of patients and should determine whether powered prostheses can decrease the risk of falls in patients with a transtibial amputation.

Keywords

Ground Reaction Force Stance Phase Vertical Ground Reaction Force Lower Extremity Amputation External Moment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank BiOM for providing prostheses and technical assistance.

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Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Susan D’Andrea
    • 1
  • Natalie Wilhelm
    • 1
  • Anne K. Silverman
    • 2
  • Alena M. Grabowski
    • 3
    • 4
  1. 1.Department of Veterans AffairsProvidence VA Medical CenterProvidenceUSA
  2. 2.Colorado School of MinesGoldenUSA
  3. 3.University of Colorado BoulderBoulderUSA
  4. 4.Department of Veterans AffairsEastern Colorado Healthcare SystemDenverUSA

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