Abstract
Stride-to-stride fluctuations of joint kinematics during walking reflect a highly structured organization that is characteristic of healthy gait. The organization of stride-to-stride fluctuations is disturbed in lower-limb prosthesis users, yet the factors contributing to this difference are unclear. One potential contributor to the changes in stride-to-stride fluctuations is the altered push-off mechanics experienced by passive prosthesis users. The purpose of our study was to determine if changes in push-off mechanics affect stride-to-stride fluctuations in transtibial amputees. Twenty-two unilateral transtibial amputees were enrolled in the 6-week cross-over study, where High and Low Activity (based on the Medicare Functional Classification System) prostheses were worn for three weeks each. Data collection took place at the end of the third week. Participants walked on a treadmill in a motion capture laboratory to quantify stride-to-stride fluctuations of the lower extremity joint angle trajectories using the largest Lyapunov Exponent, and over floor-embedded force platforms to enable calculating push-off work from the prosthesis and the sound limb. Push-off work was 140% greater in the High Activity prosthesis compared to the Low Activity prosthesis (p < 0.001), however no significant change was observed in stride-to-stride fluctuations of the ankle between the two prosthesis types (p = 0.576). There was no significant correlation between changes in prosthesis push-off work and the largest Lyapunov exponent. Though differences in push-off work were observed between the two prosthesis types, stride-to-stride fluctuations remained similar, indicating that prosthesis propulsion mechanics may not be a strong determinant of stride-to-stride fluctuations in unpowered transtibial prosthesis users.
Highlights
ObjectivesThe purpose of our study was to determine if changes in push-off mechanics affect stride-to-stride fluctuations in transtibial amputees
During human walking, subtle fluctuations occur from stride to stride, causing the walking pattern to vary over time [1,2,3]
Because we found no difference in stride-to-stride fluctuations between High Activity and Low Activity prostheses after the adaptation period, it may be Stride-to-stride fluctuations and push-off work in transtibial amputees that stride-to-stride fluctuations are more influenced by adaptation to the prosthesis than the mechanical push-off work
Summary
The purpose of our study was to determine if changes in push-off mechanics affect stride-to-stride fluctuations in transtibial amputees. The purpose of this study was to determine the relationship between prosthesis push-off work and stride-to-stride fluctuations. Our aim was to investigate how prostheses with different energy return characteristics affect stride-to-stride fluctuations at the ankle in individuals with a unilateral transtibial amputation. We aimed to study how the changes in push-off work from prostheses may affect changes in stride-to-stride fluctuations
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