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Lower limb amputation has been associated with secondary impairments such as knee osteoarthritis in the uninvolved limb. Greater knee loading in the frontal plane has been related to severity and rate of progression in knee osteoarthritis. Reduced push-off work from the involved limb can increase uninvolved limb knee loading. However, little is known about specific effects that prosthetic foot damping may have on uninvolved limb loading. We hypothesized that uninvolved limb peak knee internal abduction moment (IAM) and loading rates would be greater when using a high-damping foot compared with a low-damping foot, across walking speeds. Eight healthy, young subjects walked in a prosthesis simulator boot using the experimental feet. Greater uninvolved limb first peak IAM (+16% in fast speed, P = .002; +11% in slow speed, P = .001) and loading rates (+11% in fast speed, P = .003) were observed when using the high-damping foot compared with low-damping foot. Within each foot, uninvolved limb first peak IAM and loading rates had a trend to increase with increased walking speed. These findings suggest that damping properties of prosthetic feet are related to uninvolved limb peak knee IAM and loading rates. [ABSTRACT FROM AUTHOR]

This paper presents the design and validation of a novel lower limb prosthesis called the variable stiffness foot (VSF), designed to vary its forefoot stiffness in response to user activity. The VSF is designed as a semi-active device that adjusts its stiffness once per stride during swing phases, in order to minimize size, mass, and power consumption. The forefoot keel is designed as an overhung composite beam, whose stiffness is varied by moving a support fulcrum to change the length of the overhang. Stiffness modulation is programmed in response to the gait characteristics detected through foot trajectory reconstruction based on an embedded inertial sensor. The prototype VSF has a mass of only 649 g including the battery, and a build height of 87 mm. Mechanical testing demonstrated a forefoot stiffness range of 10–32 N/mm for the prototype, a threefold range of stiffness variation. The stiffness range can be altered by changing the keel material or geometry. Actuation testing showed that the VSF can make a full-scale stiffness adjustment within three strides, and tracks moderate speed-driven variations within one swing phase. Human subjects testing demonstrated greater energy storage and return with lower stiffness settings. This capability may be useful for the modulating prosthesis energy return to better mimic human ankle function. Subjective feedback indicated clear perception by the subjects of contrasts among the stiffness settings, including interpretation of scenarios for which different settings may be beneficial. Future applications of the VSF include adapting stiffness to optimize stairs, ramps, turns, and standing. [ABSTRACT FROM AUTHOR]

Abstract: We propose a new method for calibrating force plates to reduce errors in center of pressure locations, forces, and moments. These errors may be caused by imperfect mounting of force plates to the ground or by installation of a treadmill atop a force plate, which may introduce distorting loads. The method, termed the Post-Installation Least-Squares (PILS) calibration, combines features of several previous methods into a simple procedure. It requires a motion capture system and an instrumented pole for applying reference loads. Reference loads may be manually applied to the force plate in arbitrary locations and directions. The instrumented pole measures applied load magnitudes through a single-axis load cell, and load directions through motion capture markers. Reference data and imperfect force plate signals are then combined to form a linear calibration matrix that simultaneously minimizes mean square errors in all forces and moments. We applied the procedure to standard laboratory force plates, as well as a custom-built, split-belt force treadmill. We also collected an independent set of verification data for testing. The proposed calibration procedure was found to reduce force errors by over 20%, and moment errors by over 60%. Center of pressure errors were also reduced by 63% for standard force plates and 91% for the force treadmill. The instrumented pole is advantageous because it allows for fast and arbitrary load application without needing a precise fixture for aligning loads. The linear calibration matrix is simpler than nonlinear correction equations and more compatible with standard data acquisition software, yet it yields error reductions comparable to more complex methods. [Copyright &y& Elsevier]

Inertial measurement units (IMUs) are small wearable sensors that have tremendous potential to be applied to clinical gait analysis. They allow objective evaluation of gait and movement disorders outside the clinic and research laboratory, and permit evaluation on large numbers of steps. However, repeatability and validity data of these systems are sparse for gait metrics. The purpose of this study was to determine the validity and between-day repeatability of spatiotemporal metrics (gait speed, stance percent, swing percent, gait cycle time, stride length, cadence, and step duration) as measured with the APDM Opal IMUs and Mobility Lab system. We collected data on 39 healthy subjects. Subjects were tested over two days while walking on a standard treadmill, split-belt treadmill, or overground, with IMUs placed in two locations: both feet and both ankles. The spatiotemporal measurements taken with the IMU system were validated against data from an instrumented treadmill, or using standard clinical procedures. Repeatability and minimally detectable change (MDC) of the system was calculated between days. IMUs displayed high to moderate validity when measuring most of the gait metrics tested. Additionally, these measurements appear to be repeatable when used on the treadmill and overground. The foot configuration of the IMUs appeared to better measure gait parameters; however, both the foot and ankle configurations demonstrated good repeatability. In conclusion, the IMU system in this study appears to be both accurate and repeatable for measuring spatiotemporal gait parameters in healthy young adults. [ABSTRACT FROM AUTHOR]

Abstract: Gait parameters such as stride length, width, and period, as well as their respective variabilities, are widely used as indicators of mobility and walking function. Foot placement and its variability have thus been applied in areas such as aging, fall risk, spinal cord injury, diabetic neuropathy, and neurological conditions. But a drawback is that these measures are presently best obtained with specialized laboratory equipment such as motion capture systems and instrumented walkways, which may not be available in many clinics and certainly not during daily activities. One alternative is to fix inertial measurement units (IMUs) to the feet or body to gather motion data. However, few existing methods measure foot placement directly, due to drift associated with inertial data. We developed a method to measure stride-to-stride foot placement in unconstrained environments, and tested whether it can accurately quantify gait parameters over long walking distances. The method uses ground contact conditions to correct for drift, and state estimation algorithms to improve estimation of angular orientation. We tested the method with healthy adults walking over-ground, averaging 93 steps per trial, using a mobile motion capture system to provide reference data. We found IMU estimates of mean stride length and duration within 1% of motion capture, and standard deviations of length and width within 4% of motion capture. Step width cannot be directly estimated by IMUs, although lateral stride variability can. Inertial sensors measure walks over arbitrary distances, yielding estimates with good statistical confidence. Gait can thus be measured in a variety of environments, and even applied to long-term monitoring of everyday walking. [Copyright &y& Elsevier]

Abstract: The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. [Copyright &y& Elsevier]