Prosthetic push-off power in trans-tibial amputee level ground walking: A systematic review.

Roy Müller,Rainer Abel,Lisa Tronicke,Knut Lechler,Arezoo Eshraghi

doi:10.1371/journal.pone.0225032

Roy Müller, Rainer Abel + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0225032

Copy DOI

Abstract

ObjectiveUnilateral trans-tibial amputation signifies a challenge to locomotion. Prosthetic ankle-foot units are developed to mimic the missing biological system which adapts push-off power to walking speed in some new prosthetic ankle-foot designs. The first systematic review including the two factors aims to investigate push-off power differences among Solid Ankle Cushion Heel (SACH), Energy Storage And Return (ESAR) and Powered ankle-foot units (PWR) and their relation to walking speed.Data sourcesA literature search was undertaken in the Web of Science, PubMed, IEEE xplore, and Google Scholar databases. The search term included: ampu* AND prosth* AND ankle-power AND push-off AND walking.Study appraisal and synthesis methodsStudies were included if they met the following criteria: unilateral trans-tibial amputees, lower limb prosthesis, reported analysis of ankle power during walking. Data extracted from the included studies were clinical population, type of the prosthetic ankle-foot units (SACH, ESAR, PWR), walking speed, and peak ankle power. Linear regression was used to determine whether the push-off power of different prosthetic ankle-foot units varied regarding walking speed. Push-off power of the different prosthetic ankle-foot units were compared using one-way between subjects’ ANOVAs with post hoc analysis, separately for slower and faster walking speeds.Results474 publications were retrieved, 28 of which were eligible for inclusion. Correlations between walking speed and peak push-off power were found for ESAR (r = 0.568, p = 0.006) and PWR (r = 0.820, p = 0.000) but not for SACH (r = 0.267, p = 0.522). ESAR and PWR demonstrated significant differences in push-off power for slower and faster walking speeds (ESAR (p = 0.01) and PWR (p = 0.02)).ConclusionPush-off power can be used as a selection criterion to differentiate ankle-foot units for prosthetic users and their bandwidth of walking speeds.

Highlights

The total number of individuals with lower extremity amputations in the US is expected to increase up to 3.6 million by 2050 and it is estimated that 38% of all amputations will be major lower limb amputations [1]
Correlations between walking speed and peak push-off power were found for Energy Storage And Return (ESAR) (r = 0.568, p = 0.006) and Powered ankle-foot units (PWR) (r = 0.820, p = 0.000) but not for Solid Ankle Cushion Heel (SACH) (r = 0.267, p = 0.522)
Statistical analysis (SPSS 20; Chicago, IL, USA) was performed using linear regression to determine whether the ankle push-off power of different types (SACH, ESAR, and PWR) of pre-market and commercial ankle-foot units varied with regard to walking speed

Summary

Objective

(https://www.ossur.com/?select-defaultdestination=1), provided support in the form of salaries for authors R.M., L.M., R.A. and K.L., but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Studies were included if they met the following criteria: unilateral trans-tibial amputees, lower limb prosthesis, reported analysis of ankle power during walking. Data extracted from the included studies were clinical population, type of the prosthetic ankle-foot units (SACH, ESAR, PWR), walking speed, and peak ankle power. Linear regression was used to determine whether the push-off power of different prosthetic ankle-foot units varied regarding walking speed. Push-off power of the different prosthetic ankle-foot units were compared using one-way between subjects’ ANOVAs with post hoc analysis, separately for slower and faster walking speeds

Results

Introduction

Materials and methods

Discussion

Methods

Competing interests statement