THE INFLUENCE OF HYDRAULIC ANKLES AND MICROPROCESSOR-CONTROL ON THE BIOMECHANICS OF TRANS-TIBIAL AMPUTEES DURING QUIET STANDING ON A 5° SLOPE

ABSTRACT

BACKGROUND: Lower limb amputees have a high incidence of comorbidities, such as osteoarthritis, which are believed to be caused by kinetic asymmetries. A lack of prosthetic adaptation to different terrains requires kinematic compensations, which may influence these asymmetries.

METHOD: Six SIGAM grade E-F trans-tibial amputees (one bilateral) wore motion capture markers while standing on force plates, facing down a 5° slope. The participants were tested under three prosthetic conditions; a fixed attachment foot (FIX), a hydraulic ankle (HYD) and a microprocessor foot with a ‘standing support’ mode (MPF). The resultant ground reaction force (GRF) and support moment for prosthetic and sound limbs were chosen as outcome measures. These were compared between prosthetic conditions and to previously captured able-bodied control data.

RESULTS: The distribution of GRF between sound and prosthetic limbs was not significantly affected by foot type. However, the MPF condition required fewer kinematic compensations, leading to a reduction in sound side support moment of 59% (p=0.001) and prosthetic side support moment of 43% (p=0.02) compared to FIX. For the bilateral participant, only the MPF positioned the GRF vector anterior to the knees, reducing the demand on the residual joints to maintain posture.

CONCLUSION: For trans-tibial amputees, loading on lower limb joints is affected by prosthetic foot technology, due to the kinematic compensations required for slope adaptation. MPFs with ‘standing support’ might be considered reasonable and necessary for bilateral amputees, or amputees with stability problems due to the reduced biomechanical compensations evident.

LAYMAN’S ABSTRACT:

Lower limb prostheses work well on flat ground but often don’t adapt well to uneven ground or slopes. As a result, amputees tend to put more of their weight through their healthy leg. This can lead to problems like back pain and arthritis. In this study, the posture and weight distribution of below knee amputees were analysed while they stood facing down a slope. They did this with three different prosthetic feet; one with no ‘ankle’ joint, one with an ‘ankle’ (which could always move) and one with a computer-controlled ‘ankle’ (which could adapt to the slope but then resist movement when the wearer was stood still). Changing the prosthetic feet did not affect the amount of weight put through each limb, but when they had ‘ankle’ joints, the amputees were able to stand up straight, with a better posture. This meant that the demand on their joints was reduced, particularly on the healthy limb. One participant had below knee amputations on both legs. For this participant, only the computer-controlled device allowed her to stand up straight and well balanced.