Investigating the Effect of Real-Time Center of Pressure Feedback Training on the Swing Phase of Lower Limb Kinematics in Transfemoral Prostheses With SACH Foot.

Abstract

Transfemoral amputee often encounters reduced toe clearance resulting in trip-related falls. Swing-phase joint angles have been shown to influence the toe clearance; therefore, training intervention that targets shaping the swing phase joint angles can potentially enhance toe clearance. The focus of this study was to investigate the effect of the shift in the location of the center of pressure (CoP) during heel strike on modulation of the swing-phase joint angles in able-bodied participants (n = 6) and transfemoral amputees (n = 3). We first developed a real-time CoP-based visual feedback system such that participants could shift the CoP during treadmill walking. Next, the kinematic data were collected during two different walking sessions-baseline (without feedback) and feedback (shifting the CoP anteriorly/posteriorly at heel strike to match the target CoP location). Primary swing-phase joint angle adaptations were observed with feedback such that during the midswing phase, posterior CoP shift feedback significantly increases (p < 0.05) the average hip and knee flexion angle by 11.55 deg and 11.86 deg, respectively, in amputees, whereas a significant increase (p < 0.05) in ankle dorsiflexion, hip and knee flexion angle by 3.60 deg, 3.22 deg, and 1.27 deg, respectively, compared to baseline was observed in able-bodied participants. Moreover, an opposite kinematic adaptation was seen during anterior CoP shift feedback. Overall, results confirm a direct correlation between the CoP shift and the modulation in the swing-phase lower limb joint angles.