Perceptions and biomechanical effects of varying prosthetic ankle stiffness during uphill walking: A case series.

BACKGROUND: Prosthetic foot stiffness, which is typically invariable for commercially available prosthetic feet, needs to be considered when prescribing a prosthetic foot. While a biological foot adapts its function according to the movement task, an individual with lower limb amputation may be limited during more functionally demanding gait tasks by their conventional energy storing and return prosthetic foot. RESEARCH QUESTION: How do changes in prosthetic foot stiffness during incline walking affect biomechanical measures as well as perception of participants. METHODS: Kinetic and kinematic data were collected during incline walking, for five participants with trans-tibial amputation. A mixed model analysis of variance was used to analyse the effects of changing the stiffness during incline walking, using a novel variable-stiffness unit built on a commercially available prosthetic foot. Biomechanical results were also analysed on an individual level alongside the participant feedback, for a better understanding of the various strategies and perceptions exhibited during incline walking. RESULTS: Statistically significant effects were only observed on the biomechanical parameters directly related to prosthetic ankle kinematics and kinetics (i.e., peak prosthetic ankle dorsiflexion, peak prosthetic ankle power, dynamic joint stiffness during controlled dorsiflexion). Participant perception during walking was affected by changes in stiffness. Individual analyses revealed varied perceptions and varied biomechanical responses among participants. SIGNIFICANCE: While changes in prosthesis mechanical properties influenced the amputee's experience, minimal immediate effects were found with the overall gait pattern. The reported inter-participant variability may be due to the person's physical characteristics or habitual gait pattern, which may influence prosthesis function. The ability to vary prosthetic foot stiffness during the assessment phase of setting up a prosthesis could provide useful information to guide selection of the appropriate prosthetic device for acceptable performance across a range of activities.

Variable stiffness foot design and validation.

Energy storing and returning prosthetic feet are commonly prescribed. Research has demonstrated advantages to use these types of prosthetic feet. However, their stiffness in the sagittal plane is fixed and cannot adapt to different walking tasks and user preference. In this paper, we propose a novel prosthetic foot design capable of modulating its stiffness in the sagittal plane. The Variable Stiffness Ankle unit (VSA) is mounted on a commercially available prosthetic foot. The stiffness of the foot is adjusted with a lightweight servo motor controlled wirelessly. The stiffness change is accomplished by moving the supports points on the glass fiber leaf spring of the VSA ankle unit. We described the design and characterized changes in ankle stiffness using a mechanical test bench. A novel method was used to capture mechanical test data using a six degree of freedom load cell, allowing us to contrast mechanical and biomechanical data. A transtibial unilateral amputee performed level ground walking on an instrumented treadmill. The VSA prosthetic foot exhibited ankle stiffness change in the mechanical test bench. Ankle stiffness changes were also confirmed during the biomechanical analysis. Future work will involve additional subjects. The VSA prosthetic foot could improve user satisfaction and help prosthetist to fine tune prosthetic feet during fittings.