title: Energetic consequences of using a prosthesis with adaptive ankle motion during slope walking in persons with a transtibial amputation.
abstract: BACKGROUND
  Technological advances in prosthetic design include the use of microprocessors that adapt device performance based on user motion. The Proprio ankle unit prepositions the foot to adjust for walking on slopes and increases foot clearance during swing to minimize gait deviations.
  
  
  METHODS
  Comparative analysis.
  
  
  OBJECTIVE
  To investigate the effect of a prosthesis with adaptive ankle motion on physiological gait performance during slope walking.
  
  
  METHODS
  Six persons with a unilateral transtibial amputation completed treadmill walking tests at three slopes (-5°, 0°, and 5°). The participants were tested wearing a customary device, active Proprio (Pon), and an identical inactivated Proprio (Poff).
  
  
  RESULTS
  Metabolic energy expenditure, energy cost for walking, and rating of walking difficulty were not statistically different between the Pon and Poff for all tested slopes. However, for slope descent, energy expenditure and energy cost for walking improved significantly by an average of 10%-14% for both the Pon and Poff compared to the customary limb. Rating of walking difficulty also showed an improvement with slope descent for both the Pon and Poff compared to the customary device. An improvement with slope ascent was found for Pon compared to the customary limb only.
  
  
  CONCLUSIONS
  Adaptive ankle motion provided no meaningful physiological benefit during slope walking. The Proprio was, however, less demanding than the customary device for slope descent. Differences in the mechanical properties of the prosthetic feet likely contributed to the changes.
  
  
  CONCLUSIONS
  While the adaptive ankle motion did not affect metabolic energy expenditure or energy cost for walking, the results suggest close attention should be paid to the mechanical properties of the foot component. Assessment of gait on nonlevel surfaces is recommended to better understand the implications of different prosthetic design features.
authors.affiliation: 1Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Darter
authors.forename: Jason M
authors.initials: JM
authors.lastname: Wilken
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000328:Adult; D000674:Amputees / Q000534:rehabilitation*; D000843:Ankle Joint; D001186:Artificial Limbs; D001696:Biomechanical Phenomena / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008838:Microcomputers; D010101:Oxygen Consumption; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery*; D016138:Walking / Q000502:physiology*
keywords: Proprio; amputee; gait; microprocessor; oxygen consumption; prosthetic feet