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

  • Symposium: Recent Advances in Amputation Surgery and Rehabilitation
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Acknowledgments

We thank BiOM for providing prostheses and technical assistance.

Author information

Authors and Affiliations

  1. Department of Veterans Affairs, Providence VA Medical Center, Providence, RI, USA

    Susan D’Andrea PhD & Natalie Wilhelm BA

  2. Colorado School of Mines, Golden, CO, USA

    Anne K. Silverman PhD

  3. University of Colorado Boulder, 354 UCB, Boulder, CO, 80309, USA

    Alena M. Grabowski PhD

  4. Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, CO, USA

    Alena M. Grabowski PhD

Authors
  1. Susan D’Andrea PhD
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  2. Natalie Wilhelm BA
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  3. Anne K. Silverman PhD
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  4. Alena M. Grabowski PhD
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Corresponding author

Correspondence to Alena M. Grabowski PhD.

Additional information

One of the authors (AMG) received a Career Development Award from the Department of Veterans Affairs RR&D Service to support this research. This study was sponsored by Providence VAMC Center for Restorative and Regenerative Medicine (VA RR&D A3962R).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Gait and Motion Analysis Laboratory of the VA Medical Center, Center for Restorative and Regenerative Medicine, Providence, RI, USA.

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D’Andrea, S., Wilhelm, N., Silverman, A.K. et al. Does Use of a Powered Ankle-foot Prosthesis Restore Whole-body Angular Momentum During Walking at Different Speeds?. Clin Orthop Relat Res 472, 3044–3054 (2014). https://doi.org/10.1007/s11999-014-3647-1

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  • DOI: https://doi.org/10.1007/s11999-014-3647-1

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