Design and Testing of a Bionic Dancing Prosthesis

Traditionally, prosthetic leg research has focused on improving mobility for activities of daily living. Artistic expression such as dance, however, is not a common research topic and consequently prosthetic technology for dance has been severely limited for the disabled. This work focuses on investigating the ankle joint kinetics and kinematics during a Latin-American dance to provide unique motor options for disabled individuals beyond those of daily living. The objective of this study was to develop a control system for a bionic ankle prosthesis that outperforms conventional prostheses when dancing the rumba. The biomechanics of the ankle joint of a non-amputee, professional dancer were acquired for the development of the bionic control system. Subsequently, a professional dancer who received a traumatic transtibial amputation in April 2013 tested the bionic dance prosthesis and a conventional, passive prosthesis for comparison. The ability to provide similar torque-angle behavior of the biological ankle was assessed to quantify the biological realism of the prostheses. The bionic dancing prosthesis overlapped with 37 ± 6% of the non-amputee ankle torque and ankle angle data, compared to 26 ± 2% for the conventional, passive prosthesis, a statistically greater overlap (p = 0.01). This study lays the foundation for quantifying unique, expressive activity modes currently unavailable to individuals with disabilities. Future work will focus on an expansion of the methods and types of dance investigated in this work.     

Mechanical work performed by the individual legs during uphill and downhill walking

Previous studies of the mechanical work performed during uphill and downhill walking have neglected the simultaneous negative and positive work performed by the leading and trailing legs during double support. Our goal was to quantify the mechanical work performed by the individual legs across a range of uphill and downhill grades. We hypothesized that during double support, (1) with steeper uphill grade, the negative work performed by the leading leg would become negligible and the trailing leg would perform progressively greater positive work to raise the center of mass (CoM), and (2) with steeper downhill grade, the leading leg would perform progressively greater negative work to lower the CoM and the positive work performed by the trailing leg would become negligible. 11 healthy young adults (6 M/5 F, 71.0±12.3 kg) walked at 1.25 m/s on a dual-belt force-measuring treadmill at seven grades (0, ±3, ±6, ±9°). We collected three-dimensional ground reaction forces (GRFs) and used the individual limbs method to calculate the mechanical work performed by each leg. As hypothesized, the trailing leg performed progressively greater positive work with steeper uphill grade, and the leading leg performed progressively greater negative work with steeper downhill grade (p<0.005). To our surprise, unlike level-ground walking, during double support the leading leg performed considerable positive work when walking uphill and the trailing leg performed considerable negative work when walking downhill (p<0.005). To understand how humans walk uphill and downhill, it is important to consider these revealing biomechanical aspects of individual leg function and interaction during double support.     

The metabolic and mechanical costs of step time asymmetry in walking

Animals use both pendular and elastic mechanisms to minimize energy expenditure during terrestrial locomotion. Elastic gaits can be either bilaterally symmetric (e.g. run and trot) or asymmetric (e.g. skip, canter and gallop), yet only symmetric pendular gaits (e.g. walk) are observed in nature. Does minimizing metabolic and mechanical power constrain pendular gaits to temporal symmetry? We measured rates of metabolic energy expenditure and calculated mechanical power production while healthy humans walked symmetrically and asymmetrically at a range of step and stride times. We found that walking with a 42 per cent step time asymmetry required 80 per cent (2.5 W kg⁻¹) more metabolic power than preferred symmetric gait. Positive mechanical power production increased by 64 per cent (approx. 0.24 W kg⁻¹), paralleling the increases we observed in metabolic power. We found that when walking asymmetrically, subjects absorbed more power during double support than during symmetric walking and compensated by increasing power production during single support. Overall, we identify inherent metabolic and mechanical costs to gait asymmetry and find that symmetry is optimal in healthy human walking.     

Kinetics of individual limbs during level and slope walking with a unilateral transtibial bone-anchored prosthesis in the cat

Ongoing animal preclinical studies on transcutaneous bone-anchored prostheses have aimed to improve biomechanics of prosthetic locomotion in people with limb loss. It is much less common to translate successful developments in human biomechanics and prosthetic research to veterinary medicine to treat animals with limb loss. Current standard of care in veterinary medicine is amputation of the whole limb if a distal segment cannot be salvaged. Bone-anchored transcutaneous prostheses, developed for people with limb loss, could be beneficial for veterinary practice. The aim of this study was to examined if and how cats utilize the limb with a bone-anchored passive transtibial prosthesis during level and slope walking. Four cats were implanted with a porous titanium implant into the right distal tibia. Ground reaction forces and full-body kinematics were recorded during level and slope (±50%) walking before and 4–6 months after implantation and prosthesis attachment. The duty factor of the prosthetic limb exceeded zero in all cats and slope conditions (p < 0.05) and was in the range of 45.0–60.6%. Thus, cats utilized the prosthetic leg for locomotion instead of walking on three legs. Ground reaction forces, power and work of the prosthetic limb were reduced compared to intact locomotion, whereas those of the contralateral hind- and forelimbs increased (p < 0.05). This asymmetry was likely caused by insufficient energy generation for propulsion by the prosthetic leg, as no signs of pain or discomfort were observed in the animals. We concluded that cats could utilize a unilateral bone-anchored transtibial prosthesis for quadrupedal level and slope locomotion.     

Mechanical and metabolic determinants of the preferred step width in human walking

We studied the selection of preferred step width in human walking by measuring mechanical and metabolic costs as a function of experimentally manipulated step width (0.00-0.45L, as a fraction of leg length L). We estimated mechanical costs from individual limb external mechanical work and metabolic costs using open circuit respirometry. The mechanical and metabolic costs both increased substantially (54 and 45%, respectively) for widths greater than the preferred value (0.15-0.45L) and with step width squared (R(2) = 0.91 and 0.83, respectively). As predicted by a three-dimensional model of walking mechanics, the increases in these costs appear to be a result of the mechanical work required for redirecting the centre of mass velocity during the transition between single stance phases (step-to-step transition costs). The metabolic cost for steps narrower than preferred (0.10-0.00L) increased by 8%, which was probably as a result of the added cost of moving the swing leg laterally in order to avoid the stance leg (lateral limb swing cost). Trade-offs between the step-to-step transition and lateral limb swing costs resulted in a minimum metabolic cost at a step width of 0.12L, which is not significantly different from foot width (0.11L) or the preferred step width (0.13L). Humans appear to prefer a step width that minimizes metabolic cost.     

Three-dimensional knee joint contact forces during walking in unilateral transtibial amputees

Individuals with unilateral transtibial amputations have greater prevalence of osteoarthritis in the intact knee joint relative to the residual leg and non-amputees, but the cause of this greater prevalence is unclear. The purpose of this study was to compare knee joint contact forces and the muscles contributing to these forces between amputees and non-amputees during walking using forward dynamics simulations. We predicted that the intact knee contact forces would be higher than those of the residual leg and non-amputees. In the axial and mediolateral directions, the intact and non-amputee legs had greater peak tibio-femoral contact forces and impulses relative to the residual leg. The peak axial contact force was greater in the intact leg relative to the non-amputee leg, but the stance phase impulse was greater in the non-amputee leg. The vasti and hamstrings muscles in early stance and gastrocnemius in late stance were the largest contributors to the joint contact forces in the non-amputee and intact legs. Through dynamic coupling, the soleus and gluteus medius also had large contributions, even though they do not span the knee joint. In the residual leg, the prosthesis had large contributions to the joint forces, similar to the soleus in the intact and non-amputee legs. These results identify the muscles that contribute to knee joint contact forces during transtibial amputee walking and suggest that the peak knee contact forces may be more important than the knee contact impulses in explaining the high prevalence of intact leg osteoarthritis.     

Two biomechanical strategies for locomotor adaptation to split-belt treadmill walking in subjects with and without transtibial amputation

Locomotor adaptation is commonly studied using split-belt treadmill walking, in which each foot is placed on a belt moving at a different speed. As subjects adapt to split-belt walking, they reduce metabolic power, but the biomechanical mechanism behind this improved efficiency is unknown. Analyzing mechanical work performed by the legs and joints during split-belt adaptation could reveal this mechanism. Because ankle work in the step-to-step transition is more efficient than hip work, we hypothesized that control subjects would reduce hip work on the fast belt and increase ankle work during the step-to-step transition as they adapted. We further hypothesized that subjects with unilateral, trans-tibial amputation would instead increase propulsive work from their intact leg on the slow belt. Control subjects reduced hip work and shifted more ankle work to the step-to-step transition, supporting our hypothesis. Contrary to our second hypothesis, intact leg work, ankle work and hip work in amputees were unchanged during adaptation. Furthermore, all subjects increased collisional energy loss on the fast belt, but did not increase propulsive work. This was possible because subjects moved further backward during fast leg single support in late adaptation than in early adaptation, compensating by reducing backward movement in slow leg single support. In summary, subjects used two strategies to improve mechanical efficiency in split-belt walking adaptation: a CoM displacement strategy that allows for less forward propulsion on the fast belt; and, an ankle timing strategy that allows efficient ankle work in the step-to-step transition to increase while reducing inefficient hip work.     

Whole-body angular momentum during stair walking using passive and powered lower-limb prostheses*

Individuals with a unilateral transtibial amputation have a greater risk of falling compared to able-bodied individuals, and falling on stairs can lead to serious injuries. Individuals with transtibial amputations have lost ankle plantarflexor muscle function, which is critical for regulating whole-body angular momentum to maintain dynamic balance. Recently, powered prostheses have been designed to provide active ankle power generation with the goal of restoring biological ankle function. However, the effects of using a powered prosthesis on the regulation of whole-body angular momentum are unknown. The purpose of this study was to use angular momentum to evaluate dynamic balance in individuals with a transtibial amputation using powered and passive prostheses relative to able-bodied individuals during stair ascent and descent. Ground reaction forces, external moment arms, and joint powers were also investigated to interpret the angular momentum results. A key result was that individuals with an amputation had a larger range of sagittal-plane angular momentum during prosthetic limb stance compared to able-bodied individuals during stair ascent. There were no significant differences in the frontal, transverse, or sagittal-plane ranges of angular momentum or maximum magnitude of the angular momentum vector between the passive and powered prostheses during stair ascent or descent. These results indicate that individuals with an amputation have altered angular momentum trajectories during stair walking compared to able-bodied individuals, which may contribute to an increased fall risk. The results also suggest that a powered prosthesis provides no distinct advantage over a passive prosthesis in maintaining dynamic balance during stair walking.     

Dynamic arm swinging in human walking

Humans tend to swing their arms when they walk, a curious behaviour since the arms play no obvious role in bipedal gait. It might be costly to use muscles to swing the arms, and it is unclear whether potential benefits elsewhere in the body would justify such costs. To examine these costs and benefits, we developed a passive dynamic walking model with free-swinging arms. Even with no torques driving the arms or legs, the model produced walking gaits with arm swinging similar to humans. Passive gaits with arm phasing opposite to normal were also found, but these induced a much greater reaction moment from the ground, which could require muscular effort in humans. We therefore hypothesized that the reduction of this moment may explain the physiological benefit of arm swinging. Experimental measurements of humans (n = 10) showed that normal arm swinging required minimal shoulder torque, while volitionally holding the arms still required 12 per cent more metabolic energy. Among measures of gait mechanics, vertical ground reaction moment was most affected by arm swinging and increased by 63 per cent without it. Walking with opposite-to-normal arm phasing required minimal shoulder effort but magnified the ground reaction moment, causing metabolic rate to increase by 26 per cent. Passive dynamics appear to make arm swinging easy, while indirect benefits from reduced vertical moments make it worthwhile overall.     

Early Walking of Geriatric Amputees

After amputation geriatric patients have been enabled to get up and walk with the help of a prosthesis, an “early walking aid.” The physiotherapist measures the patient, fits the early walking aid, and instructs him in walking. The prosthesis is simple to make, easy to apply, and allows early walking with the use of a walking frame or sticks. Thus the geriatric amputee can walk as soon after operation as his general condition allows and the surgeon wishes.     

A simple model of bipedal walking predicts the preferred speed-step length relationship

We used a simple model of passive dynamic walking, with the addition of active powering on level ground, to study the preferred relationship between speed and step length in humans. We tested several hypothetical metabolic costs, with one component proportional to the mechanical work associated with pushing off with the stance leg at toe-off, and another component associated with several possible costs of forcing oscillations of the swing leg. For this second component, a cost based on the amount of force needed to oscillate the leg divided by the time duration of that force predicts the preferred speed-step length relationship much better than other costs, such as the amount of mechanical work done in swinging the leg. The cost of force/time models the need to recruit fast muscle fibers for large forces at short durations. The actual mechanical work performed by muscles on the swing leg appears to be of relatively less importance, although it appears to be minimized by the use of short bursts of muscle activity in near-isometric conditions. The combined minimization of toe-off mechanical work and force divided by time predicts the preferred speed-step length relationship.     

The effect of direct measurement versus cadaver estimates of anthropometry in the calculation of joint moments during above-knee prosthetic gait in pediatrics

Joint reaction forces, moments and powers are important in interpreting gait mechanics and compensatory strategies used by patients walking with above-knee prostheses. Segmental anthropometrics, required to calculate joint moments, are often estimated using data from cadaver studies. However, these values may not be accurate for patients following amputation as prostheses are composed of non-biologic material. The purpose of this study was to compare joint moments using anthropometrics calculated from cadaver studies versus direct measurements of the residual limb and prosthesis for children with an above-knee amputation. Gait data were collected for four subjects with above-knee prostheses walking at preferred and fast speeds. Joint moments were computed using anthropometrics from cadaver studies and direct measurements for each subject. The difference between these two methods primarily affected the inertia couple (Ialpha term) and the inertial effect due to gravity, which comprised a greater percentage of the total joint moment during swing as compared to stance. Peak hip and knee flexor and extensor moments during swing were significantly greater when calculated using cadaver data (p<0.05). These differences were greater while walking fast as compared to slow speeds. A significant difference was not found between these two methods for peak hip and knee moments during stance. A significant difference was found for peak ankle joint moments during stance, but the magnitude was not clinically important. These results support the use of direct measurements of anthropometry when examining above-knee prosthetic gait, particularly during swing.     

Effects of obesity and sex on the energetic cost and preferred speed of walking.

The metabolic energy cost of walking is determined, to a large degree, by body mass, but it is not clear how body composition and mass distribution influence this cost. We tested the hypothesis that walking would be most expensive for obese women compared with obese men and normal-weight women and men. Furthermore, we hypothesized that for all groups, preferred walking speed would correspond to the speed that minimized the gross energy cost per distance. We measured body composition, maximal oxygen consumption, and preferred walking speed of 39 (19 class II obese, 20 normal weight) women and men. We also measured oxygen consumption and carbon dioxide production while the subjects walked on a level treadmill at six speeds (0.50-1.75 m/s). Both obesity and sex affected the net metabolic rate (W/kg) of walking. Net metabolic rates of obese subjects were only approximately 10% greater (per kg) than for normal-weight subjects, and net metabolic rates for women were approximately 10% greater than for men. The increase in net metabolic rate at faster walking speeds was greatest in obese women compared with the other groups. Preferred walking speed was not different across groups (1.42 m/s) and was near the speed that minimized gross energy cost per distance. Surprisingly, mass distribution (thigh mass/body mass) was not related to net metabolic rate, but body composition (% fat) was (r2= 0.43). Detailed biomechanical studies of walking are needed to investigate whether obese individuals adopt novel energy saving mechanisms during walking.     

Muscle and prosthesis contributions to amputee walking mechanics: A modeling study

Unilateral, below-knee amputees have altered gait mechanics, which can significantly affect their mobility. Below-knee amputees lose the functional use of the ankle muscles, which are critical during walking to provide body support, forward propulsion, leg-swing initiation and mediolateral balance. Thus, either muscles must compensate or the prosthesis must provide the functional tasks normally provided by the ankle muscles. Three-dimensional (3D) forward dynamics simulations of amputee and non-amputee walking were generated to identify muscle and prosthesis contributions to amputee walking mechanics, including the subtasks of body support, forward propulsion, leg-swing initiation and mediolateral balance. Results showed that the prosthesis provided body support in the absence of the ankle muscles. The prosthesis contributed to braking from early to mid-stance and propulsion in late stance. The prosthesis also functioned like the uniarticular soleus muscle by transferring energy from the residual leg to the trunk to provide trunk propulsion. The residual-leg vasti and rectus femoris reduced their contributions to braking in early stance, which mitigated braking from the prosthesis during this period. The prosthesis did not replace the function of the gastrocnemius, which normally generates energy to the leg to initiate swing. As a result, lower overall energy was delivered to the residual leg. The prosthesis also acted to accelerate the body laterally in the absence of the ankle muscles. These results provide further insight into muscle and prosthesis function in below-knee amputee walking and can help guide rehabilitation methods and device designs to improve amputee mobility.     

Engineering Platform and Experimental Protocol for Design and Evaluation of a Neurally-controlled Powered Transfemoral Prosthesis

To enable intuitive operation of powered artificial legs, an interface between user and prosthesis that can recognize the user''s movement intent is desired. A novel neural-machine interface (NMI) based on neuromuscular-mechanical fusion developed in our previous study has demonstrated a great potential to accurately identify the intended movement of transfemoral amputees. However, this interface has not yet been integrated with a powered prosthetic leg for true neural control. This study aimed to report (1) a flexible platform to implement and optimize neural control of powered lower limb prosthesis and (2) an experimental setup and protocol to evaluate neural prosthesis control on patients with lower limb amputations. First a platform based on a PC and a visual programming environment were developed to implement the prosthesis control algorithms, including NMI training algorithm, NMI online testing algorithm, and intrinsic control algorithm. To demonstrate the function of this platform, in this study the NMI based on neuromuscular-mechanical fusion was hierarchically integrated with intrinsic control of a prototypical transfemoral prosthesis. One patient with a unilateral transfemoral amputation was recruited to evaluate our implemented neural controller when performing activities, such as standing, level-ground walking, ramp ascent, and ramp descent continuously in the laboratory. A novel experimental setup and protocol were developed in order to test the new prosthesis control safely and efficiently. The presented proof-of-concept platform and experimental setup and protocol could aid the future development and application of neurally-controlled powered artificial legs.     

Energetics of actively powered locomotion using the simplest walking model

We modified an irreducibly simple model of passive dynamic walking to walk on level ground, and used it to study the energetics of walking and the preferred relationship between speed and step length in humans. Powered walking was explored using an impulse applied at toe-off immediately before heel strike, and a torque applied on the stance leg. Although both methods can supply energy through mechanical work on the center of mass, the toe-off impulse is four times less costly because it decreases the collision loss at heel strike. We also studied the use of a hip torque on the swing leg that tunes its frequency but adds no propulsive energy to gait. This spring-like actuation can further reduce the collision loss at heel strike, improving walking energetics. An idealized model yields a set of simple power laws relating the toe-off impulses and effective spring constant to the speed and step length of the corresponding gait. Simulations incorporating nonlinear equations of motion and more realistic inertial parameters show that these power laws apply to more complex models as well.     

Sideways walking: preferred is slow,slow is optimal,and optimal is expensive

When humans wish to move sideways, they almost never walk sideways, except for a step or two; they usually turn and walk facing forward. Here, we show that the experimental metabolic cost of walking sideways, per unit distance, is over three times that of forward walking. We explain this high metabolic cost with a simple mathematical model; sideways walking is expensive because it involves repeated starting and stopping. When walking sideways, our subjects preferred a low natural speed, averaging 0.575 m s⁻¹ (0.123 s.d.). Even with no prior practice, this preferred sideways walking speed is close to the metabolically optimal speed, averaging 0.610 m s⁻¹ (0.064 s.d.). Subjects were within 2.4% of their optimal metabolic cost per distance. Thus, we argue that sideways walking is avoided because it is expensive and slow, and it is slow because the optimal speed is low, not because humans cannot move sideways fast.     

Increasing step width reduces the requirements for subtalar joint moments and powers

The subtalar joint (STJ) contributes to the absorption and generation of mechanical energy (and power) during walking to maintain frontal plane stability. Previous observational studies have suggested that there may be a relationship between step width and STJ supination moment. This study directly tests the hypothesis that walking with a step width greater than preferred would reduce STJ moments, energy absorption, and power generation requirements, while increasing energy absorption at the hip during initial contact. Participants (n = 12, 7 females) were asked to walk on an instrumented treadmill at a constant velocity and cadence at a range of fixed step widths ranging from 0.1 to 0.4 times leg length (L). Walking at step widths greater than preferred (0.149 ± 0.04 L) reduced peak STJ moments at initial contact and propulsion which subsequently reduced the negative and positive work performed at the STJ. There was a 43% reduction in energy absorption (negative work) and approximately 30% decrease in positive work at the STJ as step width increased from 0.1 L to 0.4 L. An increase in energy absorption at the knee and hip was evident with an increase in step width during initial contact, although minimal mechanical changes were observed at the proximal joints during propulsion. These results suggest an increase in step width reduces the forces generated by muscles at the STJ across stance and is therefore likely to be beneficial in the prevention and treatment of their injuries. In terms of rehabilitation, the increase in mechanical costs occurring due to an increase in energy absorption by the hip and knee is of minimal concern.     

Mechanical energetic contributions from individual muscles and elastic prosthetic feet during symmetric unilateral transtibial amputee walking: a theoretical study

Energy storage and return (ESAR) foot-ankle prostheses have been developed in an effort to improve gait performance in lower-limb amputees. However, little is known about their effectiveness in providing the body segment mechanical energetics normally provided by the ankle muscles. The objective of this theoretical study was to use muscle-actuated forward dynamics simulations of unilateral transtibial amputee and non-amputee walking to identify the contributions of ESAR prostheses to trunk support, forward propulsion and leg swing initiation and how individual muscles must compensate in order to produce a normal, symmetric gait pattern. The simulation analysis revealed the ESAR prosthesis provided the necessary trunk support, but it could not provide the net trunk forward propulsion normally provided by the plantar flexors and leg swing initiation normally provided by the biarticular gastrocnemius. To compensate, the residual leg gluteus maximus and rectus femoris delivered increased energy to the trunk for forward propulsion in early stance and late stance into pre-swing, respectively, while the residual iliopsoas delivered increased energy to the leg in pre- and early swing to help initiate swing. In the intact leg, the soleus, gluteus maximus and rectus femoris delivered increased energy to the trunk for forward propulsion in the first half of stance, while the iliopsoas increased the leg energy it delivered in pre- and early swing. Thus, the energy stored and released by the ESAR prosthesis combined with these muscle compensations was able to produce a normal, symmetric gait pattern, although various neuromuscular and musculoskeletal constraints may make such a pattern non-optimal.     

Modular control of human walking: A simulation study

Recent evidence suggests that performance of complex locomotor tasks such as walking may be accomplished using a simple underlying organization of co-active muscles, or “modules”, which have been assumed to be structured to perform task-specific biomechanical functions. However, no study has explicitly tested whether the modules would actually produce the biomechanical functions associated with them or even produce a well-coordinated movement. In this study, we generated muscle-actuated forward dynamics simulations of normal walking using muscle activation modules (identified using non-negative matrix factorization) as the muscle control inputs to identify the contributions of each module to the biomechanical sub-tasks of walking (i.e., body support, forward propulsion, and leg swing). The simulation analysis showed that a simple neural control strategy involving five muscle activation modules was sufficient to perform the basic sub-tasks of walking. Module 1 (gluteus medius, vasti, and rectus femoris) primarily contributed to body support in early stance while Module 2 (soleus and gastrocnemius) contributed to both body support and propulsion in late stance. Module 3 (rectus femoris and tibialis anterior) acted to decelerate the leg in early and late swing while generating energy to the trunk throughout swing. Module 4 (hamstrings) acted to absorb leg energy (i.e., decelerate it) in late swing while increasing the leg energy in early stance. Post-hoc analysis revealed an additional module (Module 5: iliopsoas) acted to accelerate the leg forward in pre- and early swing. These results provide evidence that the identified modules can act as basic neural control elements that generate task-specific biomechanical functions to produce well-coordinated walking.