Amputee Gait Research Articles

Estimation of 3D Body Center of Mass Acceleration and Instantaneous Velocity from a Wearable Inertial Sensor Network in Transfemoral Amputee Gait: A Case Study.

The analysis of the body center of mass (BCoM) 3D kinematics provides insights on crucial aspects of locomotion, especially in populations with gait impairment such as people with amputation. In this paper, a wearable framework based on the use of different magneto-inertial measurement unit (MIMU) networks is proposed to obtain both BCoM acceleration and velocity. The proposed framework was validated as a proof of concept in one transfemoral amputee against data from force plates (acceleration) and an optoelectronic system (acceleration and velocity). The impact in terms of estimation accuracy when using a sensor network rather than a single MIMU at trunk level was also investigated. The estimated velocity and acceleration reached a strong agreement (ρ > 0.89) and good accuracy compared to reference data (normalized root mean square error (NRMSE) < 13.7%) in the anteroposterior and vertical directions when using three MIMUs on the trunk and both shanks and in all three directions when adding MIMUs on both thighs (ρ > 0.89, NRMSE ≤ 14.0% in the mediolateral direction). Conversely, only the vertical component of the BCoM kinematics was accurately captured when considering a single MIMU. These results suggest that inertial sensor networks may represent a valid alternative to laboratory-based instruments for 3D BCoM kinematics quantification in lower-limb amputees.

The Effect of Physical Activity on Residual Limb Volume, Comfort, and Gait Symmetry of Transfemoral Amputees

AbstractFor lower limb amputees, the socket fit is affected by the physical activity performed during the day. The majority of the studies in this field include only transtibial amputees and do not examine the effects of this variable. This paper aims to determine the effect of physical activity on the volume of the residual limb (RL), the comfort, and the symmetry of gait in traumatic transfemoral amputees. RL volume and gait data of five individuals were obtained at the first time of the day and after three sessions of treadmill walking. The ratio symmetry index of selected points of gait parameters was calculated. A short comfort test was used after each session. Data were analyzed throughout the tests within each subject, and statistical analysis was performed. After the physical activity, a tendency toward volume decrease was found on almost all subjects, although it was not significant. Transfemoral amputees may have smaller volume variations than transtibial after treadmill walking tasks. Significant difference was found on the symmetry index of “swing phase (SWP).” The values of gait symmetry were consistent with previous findings regarding transfemoral amputees. The lowest symmetry was noticed on the ankle kinematics. The comfort did not significantly change with the selected amount of physical activity. In subsequent research, it is recommended to increase the intensity or time of physical activity and/or increase the number of participants. These results can help the understanding of how the socket/RL interface behaves, which can improve the design and prescription of prosthetic components.

Design, development, and calibration of bipedal force-plate for post prosthesis gait rehabilitation

There is a large demand for gait balancing devices for the above knee and below knee amputees after the installation of prostheses globally due to rehabilitation problems associated with prosthesis they occupied. Conventionally various methods used for this purpose those not affordable and not accessible easily and are not feasible generally as they need a lot of space and a well-qualified trainer which is not possible. So for it is required to design and develop an in-house transient force sensing device for lower limb amputees to get balanced in their gait cycle after wearing a prosthesis. Objectives of this research is to design and develop an affordable, accessible, easy to adopt and in-house force-plate for lower limb amputees to balance in gait cycle in four successive stride length after wearing prosthesis and improve their center of pressure line and to get quality of life. A force plate is designed via cad software and fabricated by the author. In this work, researchers passed through all the faces of such as design, modeling, fabrication electronic circuitry, interfacing, programming, and calibration. With the help of this force plate, an amputee can improve their gait cycle in five stride lengths one by one. Finally we have been designed and fabricated an in-house force-plate for lower limb amputees to get balanced in their gait cycle after wearing a prosthesis. A maximum deviation of 0.4 N was found from the tare value after experiments. From this limited study we conclude that the plate designed and fabricate can be used to improve the amputee's gait cycle and it has the potential to get easy access, affordability, less space occupying features.

Experimental Demonstration of the Lower Leg Trajectory Error Framework Using Physiological Data as Inputs.

While many studies have attempted to characterize the mechanical behavior of passive prosthetic feet to understand their influence on amputee gait, the relationship between mechanical design and biomechanical performance has not yet been fully articulated from a fundamental physics perspective. A novel framework, called lower leg trajectory error (LLTE) framework, presents a means of quantitatively optimizing the constitutive model of prosthetic feet to match a reference kinematic and kinetic dataset. This framework can be used to predict the required stiffness and geometry of a prosthesis to yield a desired biomechanical response. A passive prototype foot with adjustable ankle stiffness was tested by a unilateral transtibial amputee to evaluate this framework. The foot condition with LLTE-optimal ankle stiffness enabled the user to replicate the physiological target dataset within 16% root-mean-square (RMS) error. Specifically, the measured kinematic variables matched the target kinematics within 4% RMS error. Testing a range of ankle stiffness conditions from 1.5 to 24.4 N·m/deg with the same user indicated that conditions with lower LLTE values deviated the least from the target kinematic data. Across all conditions, the framework predicted the horizontal/vertical position, and angular orientation of the lower leg during midstance within 1.0 cm, 0.3 cm, and 1.5 deg, respectively. This initial testing suggests that prosthetic feet designed with low LLTE values could offer benefits to users. The LLTE framework is agnostic to specific foot designs and kinematic/kinetic user targets, and could be used to design and customize prosthetic feet.

Effects of a Powered Knee-Ankle Prosthesis on Amputee Hip Compensations: A Case Series.

Transfemoral amputee gait often exhibits compensations due to the lack of ankle push-off power and control over swing foot position using passive prostheses. Powered prostheses can restore this functionality, but their effects on compensatory behaviors, specifically at the residual hip, are not well understood. This paper investigates residual hip compensations through walking experiments with three transfemoral amputees using a low-impedance powered knee-ankle prosthesis compared to their day-to-day passive prosthesis. The powered prosthesis used impedance control during stance for compliant interaction with the ground, a time-based push-off controller to deliver high torque and power, and phase-based trajectory tracking during swing to provide user control over foot placement. Experiments show that when subjects utilized the powered ankle push-off, less mechanical pull-off power was required from the residual hip to progress the limb forward. Overall positive work at the residual hip was reduced for 2 of 3 subjects, and negative work was reduced for all subjects. Moreover, all subjects displayed increased step length, increased propulsive impulses on the prosthetic side, and improved impulse symmetries. Hip circumduction improved for subjects who had previously exhibited this compensation on their passive prosthesis. These improvements in gait, especially reduced residual hip power and work, have the potential to reduce fatigue and overuse injuries in persons with transfemoral amputation.

Effects on ankle power and sound limb load with an active prosthetic foot

Abstract The performance of conventional prosthetic feet depends on material and construction principles. Certain powered feet can even generate net positive mechanical work in order to provide an active push-off. The aim of this study was to evaluate the influence of ankle power on the gait of transfemoral amputees. For this purpose level walking of six transfemoral amputees was analysed with a basic and an active foot and three different power settings of the latter. The results show clear advantages of the active foot in comparison with a basic foot. However, a strong relation of the sound side knee loading parameters with the varied ankle power outputs of the active foot couldn’t be shown.

Perceiving amputee gait from biological motion: kinematics cues and effect of experience level

Physical therapists (PT) and clinicians must be skilled in identifying gait features through observation to assess motor deficits in patients and intervene appropriately. Inconsistent results in the literature have led researchers to question how clinical experience influences PT’s gait perception and to seek the key kinematic features that should be trained to enhance PT’s skill. Thus, this study investigated (1) what are the informative kinematic features that allow gait-deviation perception in amputee gait and (2) whether there are differences in observational gait skills between PT and individuals with less clinical experience (PT students [PTS] and Novices). We introduced a new method that combines biological motion and principal component analysis to gradually mesh amputee and typical walking patterns. Our analysis showed that on average the accuracy rate in identifying gait deviations between PT and PTS was similar and better than Novices. Also, we found that PT’s experience was demonstrated by their better perception of gait asymmetry. The extracted principal components demonstrated that the major gait deviation of amputees was the medial–lateral body sway and spatial gait asymmetry.

Effects on prosthetic foot ankle power on transfemoral amputee gait

Prosthetic feet are available in a range of stiffness categories, however, there is limited evidence to guide optimal selection during prosthetic foot prescription. The aim of this study was to determine the effect of commercial prosthetic foot stiffness category on foot-ankle biomechanics, gait symmetry, community ambulation, and relative foot stiffness perception.Participants were fit in randomized order with three consecutive stiffness categories of a commonly-prescribed prosthetic foot. Prosthetic foot roll-over shape and ankle push-off power and work were determined via data collected during walking in a motion analysis laboratory. Step activity was recorded during community use of each foot. Self-reported perception of relative foot stiffness was assessed with an ad hoc survey.Seventeen males with transtibial amputation completed the study. Prosthetic foot roll-over radius increased with increased prosthetic foot stiffness categories (p < 0.001). Both prosthetic ankle push-off peak power and work decreased with increased foot stiffness categories (p = 0.002). There was no association between prosthetic foot stiffness category and step length symmetry or steps per day. When assessed post-accommodation, there was no association between relative foot stiffness perception and the stiffness category across prosthetic foot conditions.Prosthetic foot stiffness category was significantly associated with changes in prosthetic foot-ankle biomechanical variables, however, was not associated with changes in gait symmetry or community ambulation. Relative prosthetic foot stiffness perception after accommodation was generally inconsistent with the order of prosthetic foot stiffness categories.While there were quantifiable differences in prosthetic foot-ankle biomechanics across stiffness categories, no significant differences were detected in gait symmetry or mean daily step count in the community. Furthermore, after community use, participants perceptions of relative stiffness across feet were generally inconsistent with the order of prosthetic foot stiffness categories. These findings raise questions as to whether changes in commercial prosthetic foot stiffness category (within a clinically relevant range) affect subjective and objective measures relevant to successful outcomes from prosthetic foot prescription.

Step time asymmetry but not step length asymmetry is adapted to optimize energy cost of split‐belt treadmill walking

The relationship between spatiotemporal gait asymmetry and walking energetics is currently under debate. The split-belt treadmill paradigm has been used to study adaptation of spatiotemporal gait parameters in relation to energetics, but it remains unclear why people reduce asymmetry in step lengths, but prefer asymmetry in step times. In this study we characterized the effects of step time asymmetry and step length asymmetry on energy cost during steady-state walking on a split-belt treadmill at increasing speed-differences. Both the optimal and preferred step time asymmetry increased with greater speed differences, while preferred step lengths remained constant and nearly symmetric. Preferred asymmetric step times were energetically optimal across all speed-difference conditions, while preferred step length asymmetry was not optimal. The findings show that humans will adopt an asymmetric gait that is associated with an energy reduction and suggest that step time asymmetry plays a dominant role in shaping the energetic cost of gait asymmetry. Healthy human walking is symmetric and economical; hemiparetic and amputee gait is often asymmetric and requires more energy. Consequently, asymmetry has been attributed to account for the added energy cost of pathological gait. But it is also possible that asymmetric gait may be adopted if it is energetically optimal under certain biomechanical and neurological constraints of the locomotor system. Here, we assessed how preferred asymmetry in step times and step lengths of healthy human gait is adapted during split-belt treadmill walking and tested the hypothesis that asymmetry is adapted to optimize metabolic energy cost. Ten healthy, young participants walked on a split-belt treadmill in three conditions in which the average belt speed was always 1.25 m s-1 and the speed difference between the belts was 0.5 m s-1 , 1.0 m s-1 and 1.5 m s-1 while a range of values of step time asymmetry and step length asymmetry were enforced. We found that preferred step time asymmetry increased with greater speed differences while preferred step length asymmetry remained constant and nearly symmetric. With increasing speed differences participants increased their preferred value of step time asymmetry to coincide with the lowest energy cost. However, our results show that preferred step length asymmetry was not optimal even with extensive experience of split-belt treadmill walking. Overall, our results indicate that humans will adopt an asymmetric gait that is associated with an energy reduction and suggest that step time asymmetry plays a dominant role in shaping the energetic cost of gait asymmetry.

Investigation of the Effects of Dual-Task Balance Training on Gait and Balance in Transfemoral Amputees: A Randomized Controlled Trial

ObjectivesTo investigate the effects of dual-task balance training on static and dynamic balance, functional mobility, cognitive level, and sleep quality in individuals with transfemoral amputation. DesignRandomized controlled clinical trial. ParticipantsTransfemoral amputees (N=20). InterventionsParticipants were randomly assigned to the single-task gait and balance training group (n=10) or the dual-task gait and balance training group (n=10). Training was given in sessions of 60 min/d, 3 d/wk for 4 weeks. The single-task training group performed traditional gait and balance exercises, and the dual-task training group practiced cognitive and motor tasks while performing gait and balance exercises. Main Outcome MeasuresThe 1-leg stance test and the Four Square Step Test were used for balance assessment. The timed Up and Go test and 10-m walk test were used for gait assessment. Three test conditions to evaluate the training effects were single walking, walking while performing a cognitive task (serial subtraction), and walking while performing a motor task (tray carrying). The Montreal Cognitive Assessment scale was used for cognitive assessment and the Pittsburgh Sleep Quality Index for sleep quality assessment. ResultsBalance and mobility improved in both groups. Dual-task balance performance, functional mobility, and gait speed improved more in the dual-task training group after training (P<.05). Cognitive status and sleep quality improved significantly in the dual-task group (P<.05). ConclusionsDual-task training was more effective than single-task training in the improvement of dual-task performance and cognitive status. The inclusion of dual-task exercises in the rehabilitation program of transfemoral amputees will provide a different perspective because of increased task automation.

Lower Limb Inter-Joint Coordination of Unilateral Transfemoral Amputees: Implications for Adaptation Control

The gait of transfemoral amputees can be made smoother by adjusting the inter-joint coordination of both lower limbs. In this study, we compared the inter-joint coordination of the amputated and non-amputated limbs of unilateral amputees to able-bodied controls. Eight amputees and eight able-bodied control participants were recruited. Walking speed, stance–swing time ratio, joint angle, joint angular velocity, and inter-joint coordination parameters—including continuous relative phase (CRP) and decomposition index (DI)—of the lower-limb joint pairs in stance and swing phases were investigated. Similarity of the CRP between groups was evaluated using cross-correlation measures and root-mean-square, and the variability of the CRP was examined by deviation phase (DP). There were significant differences between the amputated limbs and controls in CRP of hip–knee and knee–ankle in stance and swing, DP of knee–ankle and hip–ankle in stance, and DI of hip–knee in swing. For the non-amputated limbs, there were significant differences in CRP and DP of knee–ankle, and DI of hip–knee in swing compared to controls. The amputees utilized unique inter-joint coordination patterns for both limbs—particularly the hip joint—to compensate for the support-capability impairment due to limb salvage and ensure foot placement accuracy.

CLINICAL GAIT ANALYSIS OF SUBJECTS WITH TRANS-FEMORAL AMPUTATION USING POLYCENTRIC FOUR-BAR LINKAGE PROSTHETIC KNEE JOINT

Background: Adequate research is not reported so far to underline the influence of commonly used polycentric knee joints on gait performance of subjects with trans-femoral amputation. Objective: The intent of this investigation is to analyze prosthetic gait of unilateral traumatic trans-femoral amputees with polycentric four-bar linkage knee and compare it with normal subjects for evaluating any asymmetry in gait performance. Methods: Objective three-dimensional gait analysis of 15 subjects [mean (age): 36.4 (10.7) years] were performed in gait lab through force plate and optoelectronic devices to measure temporal-spatial parameters, kinematic and kinetic performances. Gait patterns of amputees were compared with those of 15 individuals with normal gait to analyze distinct functionalities of existing polycentric knee. Results: Asymmetry in gait was observed between amputees and normal subjects for all variables concerned ([Formula: see text]). Amputee gait was with significantly lesser velocity, cadence with shorter step and stride length. There was significantly less hip, knee and pelvic motions, however, pelvic obliquity and rotation did not show significant difference from the normal subjects. The vertical component of the ground reaction force differed significantly between prosthetic and intact limb [49.7 (8.5)% and 90.4 (7.4)% body weight] and also from normal subjects [107.5 (2.4)% body weight] during stance ([Formula: see text]). Interpretation and Conclusion: This difference may be attributed to nonproportionate loading of limbs and mechanical adaptations for counteracting deficiencies of prosthetic side. This study will help to explain gait asymmetry in trans-femoral amputees and to identify underlying mechanisms to enhance the quality of the existing design of prosthetic knee through optimizing design parameters and utilizing appropriate materials.

Semi-active control of a swing phase dynamic model of transfemoral prosthetic device based on inverse dynamic model

Improving the gait of transfemoral amputees and making it biomimetic and stable has always been a major effort. A dynamic model of the prosthetic device can predict the kinetic and kinematic performances, when incorporated with a musculoskeletal model. In this regard, a dynamic model of a recent trend of variable damping technology will help a great deal in evaluating the performance of the prosthetic device and also in studying the effect of various parameters on the prostheses. The current paper presents the dynamic model of a single axis two segmental prosthetic knee implemented with a magneto-rheological (MR) damper as a variable damping element. The MR damper is modeled mathematically using Bouc–Wen model with model parameters evaluated by minimizing the error norms for time, displacement and velocity between the experimental and the model-generated results using a genetic algorithm. Two different experimental data sets are used, one for mathematical modeling and other to assess the accuracy of the fit model. A Proportional Derivative plus Controlled Torque controller is employed, and the parameters are tuned to minimize the error between the desired and control input torques. Further, an inverse dynamic model using Bouc–Wen model variables is assumed and validated later. This model predicts the current directly and avoids the necessity of solving any quadratic equation, which is required in the case of inverse models based on modified Bouc–Wen. The dynamic model of the prosthesis is analyzed for the swing phase alone, and the results show that the model traces the desired knee angle and also the shank reaches full knee extension at the end of this phase with terminal velocity small enough to be handled by an extension stop.

Design of a Biomimetic SACH Foot: An Experimentally Verified Finite Element Approach

The Solid Ankle Cushioned Heel (SACH) foot is a commonly prescribed prosthetic foot for the rehabilitation of lower limb amputees. From the viewpoint of its biomechanical performance, the foot is known to cause drop-off effect and asymmetry in amputee gait. Therefore, the objective of this work is to improvise the effective foot length ratio (EFLR) and the progression of the centre of pressure (CoP) of the SACH foot by providing a novel design approach that utilizes finite element analysis. Boundary conditions employed for evaluating the roll-over characteristics of prosthetic feet were numerically incorporated in this work. The non-linear mechanical behavior of the foot was included with the incorporation of large deformation, a hyperelastic material model and the Augmented Lagrangian contact formulation. Outcomes from the simulations were experimentally verified using an inverted pendulum-like apparatus, thereby substantiating the numerical approach. The design process of the SACH foot involved the modification of the elastic modulus of its components for enhancing the parameters of interest. Results obtained presented a 5.07% increase in the EFLR and a 9.29% increase in the anteroposterior progression of the CoP, which may improve amputee stability. The design solution presented may support the large user base of the SACH foot towards achieving enhanced gait characteristics during ambulation. Moreover, this work successfully demonstrates a novel design procedure for a prosthetic foot through an effective numerical implementation.

Symmetry Analysis of Amputee Gait Based on Body Center of Mass Trajectory and Discrete Fourier Transform.

The calculation of symmetry in amputee gait is a valuable tool to assess the functional aspects of lower limb prostheses and how it impacts the overall gait mechanics. This paper analyzes the vertical trajectory of the body center of mass (CoM) of a group formed by transfemoral amputees and non-amputees to quantitatively compare the symmetry level of this parameter for both cases. A decomposition of the vertical CoM into discrete Fourier series (DFS) components is performed for each subject’s CoM trajectory to identify the main components of each pattern. A DFS-based index is then calculated to quantify the CoM symmetry level. The obtained results show that the CoM displays different patterns along a gait cycle for each amputee, which differ from the sine-wave shape obtained in the non-amputee case. The CoM magnitude spectrum also reveals more coefficients for the amputee waveforms. The different CoM trajectories found in the studied subjects can be thought as the manifestation of developed compensatory mechanisms, which lead to gait asymmetries. The presence of odd components in the magnitude spectrum is related to the asymmetric behavior of the CoM trajectory, given the fact that this signal is an even function for a non-amputee gait. The DFS-based index reflects this fact due to the high value obtained for the non-amputee reference, in comparison to the low values for each amputee.

Spatio temporal parameters and symmetry in subjects ascending and descending a ramp, using three different prosthetic feet

This study aimed at evaluating spatiotemporal parameters (STP) and symmetry index (SI), commonly used for evaluating amputee gait for routine clinical use, in individuals with unilateral transtibial amputations wearing energy storage and return (ESAR) feet with fixed ankles, prosthetic feet with adaptive ankles (PFAA) and prosthetic feet with microcontrolled adaptive ankles (PFAA-MC) in ramp ascent and descent. Thirteen individuals with transtibial amputations walked up and down a ramp. The STPs were measured in the amputated and intact legs and the relationship between them was quantified using the SI. The results showed that the use of PFAA-MC decreases walking speed in ramp descent (P < 0.018). However, this was the only parameter that showed a significant change. Hence, the differences in the amputees’ gait pattern when using the above-mentioned prostheses may not be reflected by STP and their SI.

Prosthetic gait of unilateral lower-limb amputees with current and novel prostheses: A pilot study

BackgroundNovel lower-limb prostheses aim to improve the quality of locomotion of individuals with an amputation. This study evaluates the biomechanics of a novel bionic foot during walking. MethodsAble-bodied individuals (n = 7) and individuals with a transfemoral (n = 6) or transtibial amputation (n = 6) were included. Able-bodied individuals conducted one experimental trial, whereas individuals with transtibial and transfemoral amputations conducted a familiarization (with current prosthesis) and two experimental trials using a passive and bionic prosthesis. Each trial consisted of 3 bouts of 2 min of treadmill walking at different speeds. Biomechanical data were gathered using a force platform and motion capture system and analysed using Statistical Parametric Mapping and (non)-parametric tests. FindingsConventional prosthetic feet alter gait patterns and induce locomotion difficulties. While walking at a normal speed with the passive prosthesis, transtibial amputees display reduced maximum heel forces, increased ankle and trunk angular velocities at midstance, and increased knee angle during stance and swing phases on their effected side (P ≤ 0.026). Improved lower-limb kinematics was demonstrated during slow and normal speed walking with the bionic prosthesis; however, dynamic trunk stability was negatively impacted during this condition. The bionic prosthesis did not benefit transfemoral amputees at any walking speed. InterpretationTranstibial amputees can better approximate typical movement patterns at slow and normal walking speeds using the novel bionic prosthesis; however the same benefit was not observed in transfemoral amputees.

A characterisation of established unilateral transfemoral amputee gait using 3D kinematics, kinetics and oxygen consumption measures

BackgroundPersons with unilateral transfemoral (UTF) amputation are known to walk with less efficiency than able-bodied individuals, therefore understanding the gait deviations that drive this inefficiency was considered to be important. Research questionsWhat are the differences in gait outcomes between persons with UTF amputation and able-bodied persons? What is the prevalence of specific gait deviations within this group? MethodsUsing a cross-sectional study design, the level over ground gait of established prosthetics service users with UTF amputation using mechanical knee joints (n=60) were compared with able-bodied persons (n=10). Gait profile score, walking velocity, step length, step length symmetry ratio, step time symmetry ratio, vertical ground reaction force symmetry index, base of support, centre of mass deviation and metabolic energy expenditure were measured. All data were captured during walking on level ground at a self-selected speed. Prevalence of gait deviations for each UTF participant were assessed by inspection, using a predefined list of lower limb kinematic, upper body kinematic, ground reaction force and lower limb kinetic gait deviations. ResultsStatistically significant between-groups differences across all outcome measures were found, with all p-values <0.005, and effect sizes ranging from 'large' to 'huge'. The most prevalent gait deviations included: lack of prosthetic knee flexion in early stance (98%); lack of hip extension on the prosthetic side in late stance (82%): increased trunk side flexion range of motion across the gait cycle (92%); reduced anterior propulsion force on the prosthetic side in late stance (100%) and reduced prosthetic hip adduction moment in early stance (96%). SignificanceThe results of this study indicate that the magnitude of the differences between UTF amputees and able-bodied persons, across a comprehensive range of gait measures, are such that significant research into all aspects of prosthetic rehabilitation to reduce these differences is clearly justified.

Instrumented Pyramid Adapter for Amputee Gait Analysis and Powered Prosthesis Control

Novel advanced prostheses aim to improve the ambulation ability of lower-limb amputees by adapting the prosthesis mechanical behavior online during ambulation. Accurate force/torque sensing is necessary to measure the physical interaction between the user, the prosthesis, and the environment. Most available solutions consist of retrofitting an off-the-shelf load cell, which leads to suboptimal designs regarding weight and size, ultimately reducing the prosthesis usability. To address this limitation, we propose to instrument an existing prosthesis component, namely, a pyramid adapter, with force/torque sensing and an inertial measurement unit. Magnetic sensing of large structural deformations is used to improve system reliability and reduce costs. Testing shows that the proposed sensor prototype can sense up to 120 Nm and 2500 N of torque and force and has 2.1% and 8.3% nonlinearity, respectively, during walking. The total weight is 150 g—only 66 g more than a standard pyramid adapter without force/torque instrumentation. Amputee testing with robotic leg prosthesis is conducted to validate the instrumented pyramid in a case scenario.

Are wearable insoles a validated tool for quantifying transfemoral amputee gait asymmetry?

Amputee gait is known to be asymmetrical, especially during loading of the lower limb. Monitoring asymmetry could be useful in quantifying patient performance during rehabilitation. Wearable insoles can provide normal ground reaction force asymmetry in real-life conditions. To characterize the validity of Loadsol® insoles versus force plates in quantifying normal ground reaction force and gait asymmetry. To determine the influence walking speed has on loading asymmetry in transfemoral amputees. This is a prospective study. Six transfemoral amputees, wearing Loadsol® insoles, walked at three self-selected speeds on force plates. Validity was assessed by comparing normal ground reaction force data from the insoles and force plates. The Absolute Symmetry Index was used to calculate gait loading asymmetry at each speed. Normalized root mean square errors for the normal ground reaction forces were 6.6% (standard deviation = 2.3%) and 8.9% (standard deviation = 3.8%); correlation coefficients were 0.91 and 0.95 for the prosthetic and intact limb, respectively. The mean error for Absolute Symmetry Index parameters ranged from -2.67% to 4.35%. Loading asymmetry increased with walking speed. This study quantified the validity of Loadsol® insoles in assessing loading asymmetry during gait in transfemoral amputees. The calibration protocol could be improved to better integrate it into a clinical setting. However, our results support the relevance of using such insoles during the clinical follow-up of transfemoral amputees. This is the first study to validate Loadsol® insoles versus force plates and report on loading asymmetry during gait at three different speeds in transfemoral amputees. Loadsol® insoles, which provide visual and audio feedback, are clinically easy to use and could have beneficial application in the amputee's rehabilitation and follow-up.