The Biomechanics and Physiology of Human Locomotion With and Without Assistive Devices

Links

URL: https://scholar.colorado.edu/concern/graduate_thesis_or_dissertations/0v838216n

OCLC: 1492195791

Abstract

People with lower-limb amputation utilize assistive devices such as prostheses to aid locomotion, allowing them to regain physical activity and overall health and wellness. Individuals with unilateral transtibial amputation typically use running-specific prostheses to run and passive-elastic energy storage and return prostheses to walk. However, running-specific prostheses are primarily designed for level-ground conditions, and passive-elastic prostheses cannot fully replicate the function of the biological ankle and foot during walking. Moreover, individuals with lower-limb amputation face an increased risk and prevalence of secondary co-morbidities like joint pain and osteoarthritis and tend to be more sedentary compared to non-amputees. Determining the mechanical properties of the lower limb when running on slopes at varying speeds could provide a framework for the design of biomimetic assistive devices that better replicate the response of the biological joints and leg when navigating slopes. Further, investigating the biomechanics, physiology, and user-device interaction when individuals with unilateral transtibial amputation utilize prostheses could inform future device designs that might reduce the risk of secondary co-morbidities and motivate training tools for rehabilitation following amputation. The goal of this dissertation is to investigate the biomechanics and physiology of human locomotion, specifically walking and running, with and without lower-limb prostheses, and provide applications to future device design. First, I determined biological ankle and knee joint quasistiffness, theoretical leg stiffness and the contribution of the ankle and knee joints to theoretical leg stiffness when runners navigated level, uphill and downhill slopes at different speeds (Chapter 1). Then, I investigated how real-time visual feedback of peak propulsive horizontal ground reaction force effects the biomechanics and physiology of individuals with unilateral transtibial amputation when they walk with a passive-elastic energy storage and return prothesis and the BiOM stance phase powered prosthesis (Chapters 2-4).

In Chapter 1, my co-authors and I present a manuscript that is published in the Journal of Royal Society Open Science where we determined ankle and knee joint quasi-stiffness, theoretical leg stiffness and the contribution of the ankle and knee joints to theoretical leg stiffness when runners navigated level, uphill and downhill slopes at different speeds. We found that runners increase the contribution of the ankle joint and decrease the contribution of the knee joint to theoretical leg stiffness when running uphill. When running downhill, runners decrease the contribution of the ankle joint and increase the contribution of the knee joint to theoretical leg stiffness. We also found that runners increase ankle and knee quasi-stiffness to run at faster speeds. These findings suggest that device designs that detect changes in speed and slope may be needed to enable a response that mimics that of the biological lower limb.

In Chapters 2-4, my co-workers and I present work from three manuscripts where we investigate the effects of real-time visual feedback of peak propulsive horizontal ground reaction force on the biomechanics and energetics of individuals with a unilateral transtibial amputation when they walk using a passive-elastic energy storage and return prosthesis and the BiOM powered prosthesis. In Chapter 2, we found that when given visual feedback of peak propulsive horizontal ground reaction force, individuals with unilateral transtibial amputation can increase affected leg peak propulsive horizontal ground force and decrease peak propulsive horizontal ground reaction force asymmetry, but doing so incurs a greater metabolic cost when using either prosthesis. In Chapter 3, we found that when given visual feedback of peak propulsive horizontal ground reaction force, individuals with unilateral transtibial amputation can decrease trailing leg work asymmetry during the step-to-step transition. However, leading leg work asymmetry does not change when using a passive elastic prosthesis or the BiOM powered prosthesis. In Chapter 4, we found that when given visual feedback of peak propulsive horizontal ground reaction force, individuals with unilateral transtibial amputation did not increase positive affected leg ankle-foot work. Rather, positive affected leg knee work increased, perhaps a strategy adopted in an attempt to reach visual feedback targets. These results suggest that visual feedback of peak propulsive horizontal ground reaction force could be a useful rehabilitation or training tool to encourage individuals with unilateral transtibial amputation to reduce ground reaction force asymmetry when using a passive-elastic prosthesis and the BiOM. However, future device designs of a powered device should explore providing sensory feedback and device control to the user to normalize energetics and lower limb joint and leg mechanics.

Together, these studies extend our understanding of the biomechanics and physiology of running and walking with and without assistive devices and provide insight into training tools for rehabilitation following amputation and future directions for biomimetic device designs.

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