Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees

Alan R De Asha,Ramesh Munjal,Jai Kulkarni,John G Buckley

doi:10.1016/j.clinbiomech.2014.06.009

Alan R De Asha, Ramesh Munjal + Show 2 more

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https://doi.org/10.1016/j.clinbiomech.2014.06.009

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Abstract

BackgroundIf a prosthetic foot creates resistance to forwards shank rotation as it deforms during loading, it will exert a braking effect on centre of mass progression. The present study determines whether the centre of mass braking effect exerted by an amputee's habitual rigid ‘ankle’ foot was reduced when they switched to using an ‘Echelon’ hydraulic ankle–foot device. MethodsNineteen lower limb amputees (eight trans-femoral, eleven trans-tibial) walked overground using their habitual dynamic-response foot with rigid ‘ankle’ or ‘Echelon’ hydraulic ankle–foot device. Analysis determined changes in how the centre of mass was transferred onto and above the prosthetic-foot, freely chosen walking speed, and spatio-temporal parameters of gait. FindingsWhen using the hydraulic device both groups had a smoother/more rapid progression of the centre of pressure beneath the prosthetic hindfoot (p≤0.001), and a smaller reduction in centre of mass velocity during prosthetic-stance (p<0.001). As a result freely chosen walking speed was higher in both groups when using the device (p≤0.005). In both groups stance and swing times and cadence were unaffected by foot condition whereas step length tended (p<0.07) to increase bilaterally when using the hydraulic device. Effect size differences between foot types were comparable across groups. InterpretationUse of a hydraulic ankle–foot device reduced the foot's braking effect for both amputee groups. Findings suggest that attenuation of the braking effect from the foot in early stance may be more important to prosthetic-foot function than its ability to return energy in late stance.

Highlights

Available energy storing and return (ESR) and/or dynamicresponse prosthetic-feet (DRF) store and return energy during stance via elastic deformation and recoil
The aim of the present study was to determine whether the COM ‘braking effect’ exerted by unilateral trans-tibial and trans-femoral amputees' habitual rigid ‘ankle’ foot was reduced when they switched to using an ‘Echelon’ hydraulic ankle–foot device
We have previously shown that when TTs used a hyA-F compared to rigid ‘ankle’ DRF (rigF), CoP fluctuations beneath the prosthetic foot were attenuated and angular velocity of the prosthetic-shank during early stance and freely chosen walking speed were increased (De Asha et al, 2013a)

Summary

Introduction

Available energy storing and return (ESR) and/or dynamicresponse prosthetic-feet (DRF) store and return energy during stance via elastic deformation and recoil This energy return is intended to replicate the ‘power burst’ seen at the intact-ankle during terminal stance/pre-swing. The present study determines whether the centre of mass braking effect exerted by an amputee's habitual rigid ‘ankle’ foot was reduced when they switched to using an ‘Echelon’ hydraulic ankle–foot device. As a result freely chosen walking speed was higher in both groups when using the device (p ≤ 0.005) In both groups stance and swing times and cadence were unaffected by foot condition whereas step length tended (p b 0.07) to increase bilaterally when using the hydraulic device. Interpretation: Use of a hydraulic ankle–foot device reduced the foot's braking effect for both amputee groups. Findings suggest that attenuation of the braking effect from the foot in early stance may be more important to prosthetic-foot function than its ability to return energy in late stance

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