Leg stiffness of sprinters using running-specific prostheses

Running-specific prosthesis' performance characterization by dynamic finite element approach

INTRODUCTION

Composite running-specific prostheses (RSP) are widely used by athletes with lower limb amputations to simulate the spring-like behavior of biological legs. However, the effect of these devices on the biomechanics of athletes with transtibial amputations remains uncertain.

MODELING METHOD DESCRIPTION

To address this issue, this study proposes a time-dependent finite element model that uses angles and dynamic loads during ground contact to evaluate RSP performance parameters such as stiffness and energy efficiency. The study also examines the impact of running speed and RSP geometry on performance.

NUMERICAL SIMULATION AND MODEL VERIFICATION

The in-silico characterization approach used in this study takes into account both the intrinsic characteristics of the RSP and the athlete's biomechanics to identify the influence of fundamental geometric variables of the RSP on performance. The model is verified by comparing its results with experimental data.

RESULTS AND DISCUSSION

The study found that as running speed increases, RSP stiffness, vertical ground reaction force (vGRF), and contact time decrease. The force-displacement profiles of RSP are nonlinear, but a linear function can be used to accurately represent their behavior at high sprinting speeds. Using higher RSP reduces energy efficiency and vGRF due to their lower stiffness. J-curve RSP result in higher stiffness, vGRF, and strain energy, while C-curve RSP are associated with longer contact times and higher energy efficiency.

The contribution of lower-limb joint quasi-stiffness to theoretical leg stiffness during level, uphill and downhill running at different speeds

Humans change joint quasi-stiffness (k joint) and leg stiffness (kleg) when running at different speeds on level ground and during uphill and downhill running. These mechanical properties can inform device designs for running such as footwear, exoskeletons and prostheses. We measured kinetics and kinematics from 17 runners (10 M; 7 F) at three speeds on 0°, ±2°, ±4° and ±6° slopes. We calculated ankle and knee k joint, the quotient of change in joint moment and angular displacement, and theoretical leg stiffness (klegT) based on the joint external moment arms and k joint. Runners increased k ankle at faster speeds (p < 0.01). Runners increased and decreased the ankle and knee contributions to klegT, respectively, by 2.89% per 1° steeper uphill slope (p < 0.01) during the first half of stance. Runners decreased and increased ankle and knee joint contributions to klegT, respectively, by 3.68% during the first half and 0.86% during the second half of stance per 1° steeper downhill slope (p < 0.01). Thus, biomimetic devices require stiffer k ankle for faster speeds, and greater ankle contributions and greater knee contributions to klegT during the first half of stance for steeper uphill and downhill slopes, respectively.

Equivalent running leg lengths require prosthetic legs to be longer than biological legs during standing

We aimed to determine a method for prescribing a standing prosthetic leg length (ProsL) that results in an equivalent running biological leg length (BioL) for athletes with unilateral (UTTA) and bilateral transtibial amputations (BTTA). We measured standing leg length of ten non-amputee (NA) athletes, ten athletes with UTTA, and five athletes with BTTA. All athletes performed treadmill running trials from 3 m/s to their maximum speed. We calculated standing and running BioL and ProsL lengths and assessed the running-to-standing leg length ratio (L_ratio) at three instances during ground contact: touchdown, mid-stance, and take-off. Athletes with UTTA had 2.4 cm longer standing ProsL than BioL length (p = 0.030), but their ProsL length were up to 3.3 cm shorter at touchdown and 4.1 cm shorter at mid-stance than BioL, at speed 3-11.5 m/s. At touchdown, mid-stance, and take-off, athletes with BTTA had 0.01-0.05 lower L_ratio at 3 m/s (p < 0.001) and 0.03-0.07 lower L_ratio at 10 m/s (p < 0.001) in their ProsL compared to the BioL of NA athletes. During running, ProsL were consistently shorter than BioL. To achieve equivalent running leg lengths at touchdown and take-off, athletes with UTTA should set their running-specific prosthesis height so that their standing ProsL length is 2.8-4.5% longer than their BioL length, and athletes with BTTA should set their running-specific prosthesis height so that their standing ProsL lengths are at least 2.1-3.9% longer than their presumed BioL length. Setting ProsL length to match presumed biological dimensions during standing results in shorter legs during running.

A novel characterisation protocol of mechanical interactions between the ground and a tibial prosthesis for long jump

The mechanical study of Running Specific Prostheses (RSPs) is often limited to the blade. The setup developed and presented herein is a simple experiment, based on a mechanical testing machine and a camera, that assesses two indicators relevant to coaches and athletes in the field of athletics: secant stiffness and energy dissipation. The influence of four parameters on global prosthesis behaviour is evaluated: the load line offset, the prosthesis-ground angle, the sole type and the flooring type. The load line offset and the flooring type have little to no influence on their behaviour. The prosthesis-ground angle impacts the stiffness: an increase in the angle brings a significant decrease in stiffness, which strongly impacts the performance. The type of sole modifies the kinematics of the blade tip's interaction with the ground. However, this effect is less likely to enhance the sports practice since athletics imposes the use of spikes. The camera images allow assessing the local behaviour of the sole, thus enabling to follow its strain through the compression process.

Reducing cost of transport in asymmetrical gaits: lessons from unilateral skipping

PURPOSE

Unilateral skipping is an asymmetrical gait only exceptionally used by humans, due to high energetic demands. In skipping, the cost of transport decreases as speed increases, and the spring-mass model coexists with the vaulting pendular one. However, the mechanisms of energy transfers and recovery between the vaulting and the bouncing steps are still unclear in this gait. The objective of this work is to study how spatiotemporal and spring-mass asymmetries impact on metabolic cost, lowering it despite speed augmentation.

METHODS

Kinematics and metabolic rates of healthy subjects were measured during running and skipping on a treadmill at controlled speeds.

RESULTS

Metabolic power in skipping and running increased with similar slope but different intercepts. This fact determined the different behaviour of the cost of transport: constant in running, decreasing in skipping. In skipping the step time asymmetry remained constant, while the step length asymmetry decreased with speed, almost disappearing at 2.5 m/s^-1. Leg stiffness in trailing limb increased with higher slope than in leading limb and running; however, the relative leg stiffness asymmetry remained constant.

CONCLUSIONS

Slow skipping presents short bouncing steps, even shorter than the vaulting, impacting the stride mechanics and the metabolic cost. Faster speeds were achieved by taking longer bouncing steps and a stiffer trailing limb, allowing to improve the effectiveness of the spring-mass mechanism. The step asymmetries' trends with respect to speed in skipping open the possibility to use this gait as an experimental paradigm to study mechanisms of metabolic cost reduction in locomotion.

Spring-mass behavioural adaptations to acute changes in prosthetic blade stiffness during submaximal running in unilateral transtibial prosthesis users

BACKGROUND

Individuals with lower-limb amputation can use running specific prostheses (RSP) that store and then return elastic energy during stance. However, it is unclear whether varying the stiffness category of the same RSP affects spring-mass behaviour during self-selected, submaximal speed running in individuals with unilateral transtibial amputation.

RESEARCH QUESTION

The current study investigates how varying RSP stiffness affects limb stiffness, running performance, and associated joint kinetics in individuals with a unilateral transtibial amputation.

METHODS

Kinematic and ground reaction force data were collected from eight males with unilateral transtibial amputation who ran at self-selected submaximal speeds along a 15 m runway in three RSP stiffness conditions; recommended habitual stiffness (HAB) and, following 10-minutes of familiarisation, stiffness categories above (+1) and below (-1) the HAB. Stance-phase centre of mass velocity, contact time, limb stiffness' and joint/RSP work were computed for each limb across RSP stiffness conditions.

RESULTS

With increased RSP stiffness, prosthetic limb stiffness increased, whilst intact limb stiffness decreased slightly (p<0.03). Centre of mass forward velocity during stance-phase (p<0.02) and contact time (p<0.04) were higher in the intact limb and lower in the prosthetic limb but were unaffected by RSP stiffness. Intact limb hip joint positive work increased for both the +1 and -1 conditions but remained unchanged across conditions in the prosthetic limb (p<0.02).

SIGNIFICANCE

In response to changes in RSP stiffness, there were acute increased mechanical demands on the intact limb, reflecting a reliance on the intact limb during running. However, overall running speed was unaffected, suggesting participants acutely adapted to an RSP of a non-prescribed stiffness.

Running-specific prosthesis model, stiffness and height affect biomechanics and asymmetry of athletes with unilateral leg amputations across speeds

Athletes with transtibial amputation (TTA) use running-specific prostheses (RSPs) to run. RSP configuration likely affects the biomechanics of such athletes across speeds. We determined how the use of three RSP models (Catapult, Sprinter and Xtend) with three stiffness categories (recommended, ±1), and three heights (recommended, ±2 cm) affected contact length (L_c ), stance average vertical ground reaction force (F _avg), step frequency (f _step) and asymmetry between legs for 10 athletes with unilateral TTA at 3-7 m s^-1. The use of the Xtend versus Catapult RSP decreased L_c (p = 2.69 × 10^-7) and F _avg asymmetry (p = 0.032); the effect on L_c asymmetry diminished with faster speeds (p = 0.0020). The use of the Sprinter versus Catapult RSP decreased F _avg asymmetry (p = 7.00 × 10^-5); this effect was independent of speed (p = 0.90). The use of a stiffer RSP decreased L_c asymmetry (p ≤ 0.00033); this effect was independent of speed (p ≥ 0.071). The use of a shorter RSP decreased L_c (p = 5.86 × 10^-6), F _avg (p = 8.58 × 10^-6) and f _step asymmetry (p = 0.0011); each effect was independent of speed (p ≥ 0.15). To minimize asymmetry, athletes with unilateral TTA should use an Xtend or Sprinter RSP with 2 cm shorter than recommended height and stiffness based on intended speed.

Biomechanical factors affecting individuals with lower limb amputations running using running-specific prostheses: A systematic review

BACKGROUND

Running-specific prostheses (RSPs) are biomechanically designed to enable individuals with lower limb amputations to engage in high level sports.

RESEARCH QUESTION

What is the influence of RSP use on the running biomechanics of individuals with lower limb amputations?

METHODS

An article search was conducted in six databases since their inception to July 2021. Two independent reviewers assessed the title, abstract and full texts in the review process. The quality of the papers was appraised. The review included a total of 35 articles.

RESULTS

Main findings indicate force production is a limitation of RSPs. Individuals with lower limb absence employ a variety of compensatory strategies such as adjusting their step frequency, contact length and joint kinetics to improve their running performance. Leg stiffness modulation and external factors relating to the RSP design and fitting play important roles in RSP biomechanics. For individuals with unilateral amputations, the increased loading of the intact limb could increase the risk of acute injury or chronic joint degradation.

SIGNIFICANCE

To improve their running performance, runners with lower limb amputations employ various compensatory strategies, such as altering the spatiotemporal and kinetic parameters. Factors relating to RSP height, stiffness, shape, and alignment also play an important role in terms of running biomechanics and should be considered in RSP design and fitting. Future studies should focus on the use of RSPs for recreation, in pediatric populations, with certain amputation levels, as well as the impact of training and running techniques.

Sprinting with prosthetic versus biological legs: insight from experimental data

Running-prostheses have enabled exceptional athletes with bilateral leg amputations to surpass Olympic 400 m athletics qualifying standards. Due to the world-class performances and relatively fast race finishes of these athletes, many people assume that running-prostheses provide users an unfair advantage over biologically legged competitors during long sprint races. These assumptions have led athletics governing bodies to prohibit the use of running-prostheses in sanctioned non-amputee (NA) competitions, such as at the Olympics. However, here we show that no athlete with bilateral leg amputations using running-prostheses, including the fastest such athlete, exhibits a single 400 m running performance metric that is better than those achieved by NA athletes. Specifically, the best experimentally measured maximum running velocity and sprint endurance profile of athletes with prosthetic legs are similar to, but not better than those of NA athletes. Further, the best experimentally measured initial race acceleration (from 0 to 20 m), maximum velocity around curves, and velocity at aerobic capacity of athletes with prosthetic legs were 40%, 1-3% and 19% slower compared to NA athletes, respectively. Therefore, based on these 400 m performance metrics, use of prosthetic legs during 400 m running races is not unequivocally advantageous compared to the use of biological legs.

How Can Biomechanics Improve Physical Preparation and Performance in Paralympic Athletes? A Narrative Review

Recent research in Paralympic biomechanics has offered opportunities for coaches, athletes, and sports practitioners to optimize training and performance, and recent systematic reviews have served to summarize the state of the evidence connecting biomechanics to Paralympic performance. This narrative review serves to provide a comprehensive and critical evaluation of the evidence related to biomechanics and Paralympic performance published since 2016. The main themes within this review focus on sport-specific body posture: the standing, sitting, and horizontal positions of current summer Paralympic sports. For standing sports, sprint and jump mechanics were assessed in athletes with cerebral palsy and in lower-limb amputee athletes using running-specific prostheses. Our findings suggest that running and jumping-specific prostheses should be ‘tuned’ to each athlete depending on specific event demands to optimize performance. Standing sports were also inclusive to athletes with visual impairments. Sitting sports comprise of athletes performing on a bike, in a wheelchair (WC), or in a boat. WC configuration is deemed an important consideration for injury prevention, mobility, and performance. Other sitting sports like hand-cycling, rowing, and canoeing/kayaking should focus on specific sitting positions (e.g., arm-crank position, grip, or seat configuration) and ways to reduce aero/hydrodynamic drag. Para-swimming practitioners should consider athlete-specific impairments, including asymmetrical anthropometrics, on the swim-start and free-swim velocities, with special considerations for drag factors. Taken together, we provide practitioners working in Paralympic sport with specific considerations on disability and event-specific training modalities and equipment configurations to optimize performance from a biomechanical perspective.

Increases in Load Carriage Magnitude and Forced Marching Change Lower-Extremity Coordination in Physically Active, Recruit-Aged Women

The objective was to examine the interactive effects of load magnitude and locomotion pattern on lower-extremity joint angles and intralimb coordination in recruit-aged women. Twelve women walked, ran, and forced marched at body weight and with loads of +25%, and +45% of body weight on an instrumented treadmill with infrared cameras. Joint angles were assessed in the sagittal plane. Intralimb coordination of the thigh-shank and shank-foot couple was assessed with continuous relative phase. Mean absolute relative phase (entire stride) and deviation phase (stance phase) were calculated from continuous relative phase. At heel strike, forced marching exhibited greater (P < .001) hip flexion, knee extension, and ankle plantar flexion compared with running. At mid-stance, knee flexion (P = .007) and ankle dorsiflexion (P = .04) increased with increased load magnitude for all locomotion patterns. Forced marching (P = .009) demonstrated a "stiff-legged" locomotion pattern compared with running, evidenced by the more in-phase mean absolute relative phase values. Running (P = .03) and walking (P = .003) had greater deviation phase than forced marching. Deviation phase increased for running (P = .03) and walking (P < .001) with increased load magnitude but not for forced marching. With loads of >25% of body weight, forced marching may increase risk of injury due to inhibited energy attenuation up the kinetic chain and lack of variability to disperse force across different supportive structures.

'Whip from the hip': thigh angular motion, ground contact mechanics, and running speed

During high-speed running, lower limb vertical velocity at touchdown has been cited as a critical factor needed to generate large vertical forces. Additionally, greater leg angular velocity has also been correlated with increased running speeds. However, the association between these factors has not been comprehensively investigated across faster running speeds. Therefore, this investigation aimed to evaluate the relationship between running speed, thigh angular motion and vertical force determinants. It was hypothesized that thigh angular velocity would demonstrate a positive linear relationship with both running speed and lower limb vertical velocity at touchdown. A total of 40 subjects (20 males, 20 females) from various athletic backgrounds volunteered and completed 40 m running trials across a range of sub-maximal and maximal running speeds during one test session. Linear and angular kinematic data were collected from 31-39 m. The results supported the hypotheses, as across all subjects and trials (range of speeds: 3.1-10.0 m s-1), measures of thigh angular velocity demonstrated a strong positive linear correlation to speed (all R2>0.70, P<0.0001) and lower limb vertical velocity at touchdown (all R2=0.75, P<0.001). These findings suggest thigh angular velocity is strongly related to running speed and lower limb impact kinematics associated with vertical force application.

Are consumers satisfied with the use of prosthetic sports feet and the provision process? A mixed-methods study

BACKGROUND

Special feet connected to a prosthesis, prosthetic sports feet, enable athletes with a lower limb amputation to run. The selection of a prosthetic sports feet is usually based on body weight and preferred sports performance. The selection of a prosthetic sport feet is also based on clinicians who likely have limited experience due to a small number of athletes with a lower limb amputation.

HYPOTHESIS

Athletes with a lower limb amputation are not satisfied with the use and service associated with prosthetic sports feet due to a lack of prosthetic sports feet provision guidelines, poorer function of prosthetic sports feet compared to the anatomical foot and ankle, and limited experience of clinicians.

EVALUATION OF HYPOTHESIS

A mixed-methods study in 16 athletes with a lower limb amputation using a prosthetic sport foot from Össur or Otto Bock, included semi-structured interviews and quantitative analysis. Three dimensions of prosthetic sports feet were investigated: 1) use, 2) provision process, and 3) cosmetics. Qualitative data were analyzed to identify factors influencing consumer satisfaction. Quantitative data were analyzed to investigate satisfaction and perceived relative importance of the dimensions.

RESULTS

Participants were satisfied with the prosthetic sports feet use. However, they were not satisfied with the process prior to provision. The prosthetic sport feet use was perceived as the most important dimension. Sports performance was the critical element in the prosthetic sports feet use and was influenced by stability, confidence and fear, safety, focus, energy return, and comfort. Cosmetics were unimportant. Motivation to purchase the prosthetic sports feet was the key element for the prosthetic sports foot acquisition. Satisfaction about the process prior to provision was negatively influenced by poor support of professionals during rehabilitation, the complexity and duration of the purchase process, and lack of information and accessibility of prosthetic sports feet.

CONCLUSION

The most important dimension of the prosthetic sports feet was its use, which was directly influenced by performance. To further increase the satisfaction with prosthetic sports feet, clinicians should establish how to meet the desired sports performance level of athletes with a lower limb amputation. Improving the process prior to the provision process may increase satisfaction. We suggest increasing the support of professionals during rehabilitation and training through cooperation between involved services, organizing prosthetic sports feet try-out sessions, and increase the accessibility of the prosthetic sports feet. In this way, individuals with a lower limb amputation may become and stay more physically active and participate in sports.

Effect of step frequency on leg stiffness during running in unilateral transfemoral amputees

Spring-like leg behavior is a general feature of mammalian bouncing gaits, such as running and hopping. Although increases in step frequency at a given running speed are known to increase the stiffness of the leg spring (k_leg) in non-amputees, little is known about stiffness regulation in unilateral transfemoral amputees. In this study, we investigated stiffness regulation at different step frequencies at a given running speed in unilateral transfemoral amputees. We recruited nine unilateral transfemoral amputees wearing running-specific prostheses. They were asked to perform the action of running across a range of step frequencies (±20, ±15, ±10, ±5, and 0% of their preferred step frequency) at a given speed on an instrumented treadmill. The k_leg values were calculated using ground reaction force data in both the affected and unaffected limbs. It was found that k_leg increased with increasing step frequency for the unaffected limb, but not for the affected limb. Consequently, the unilateral transfemoral amputees attained the desired step frequency in the unaffected limb, but were unable to match the three highest step frequencies using their affected limbs. These results suggest that the stiffness regulation strategy during running differs between the affected and unaffected limbs.

Joint work and ground reaction forces during running with daily-use and running-specific prostheses

Some individuals with a transtibial amputation (TTA) may not have access to running-specific prostheses and therefore choose to run using their daily-use prosthesis. Unlike running-specific prostheses, daily-use prostheses are not designed for running and may result in biomechanical differences that influence injury risk. To investigate these potential differences, we assessed the effect of amputation, prosthesis type, and running speed on joint work and ground reaction forces. 13 people with and without a unilateral TTA ran at speeds ranging from 2.5 m/s to 5.0 m/s. People with TTA ran using their own daily-use and running-specific prostheses. Body kinematics and ground reaction forces were collected and used to compute joint work. People with TTA had smaller peak braking, propulsive and medial/lateral ground reaction forces from the amputated leg compared to people without TTA. People wearing running-specific prostheses had smaller peak amputated leg vertical ground reaction forces compared to daily-use prostheses at speeds above 3.5 m/s. Medial/lateral forces were also smaller in running-specific prostheses, which may present balance challenges when running on varied terrain. Running-specific prostheses stored and returned more energy and provided greater propulsion, resulting in more similar positive hip work between legs compared to daily-use prostheses. Increases in positive hip work, but not device work, highlight the importance of the hip in increasing running speed. Running-specific devices may be beneficial for joint health at running-speeds above 3.5 m/s and provide advantages in propulsion and energy return at all speeds compared to daily-use prostheses, helping people with TTA achieve faster running speeds.

Prosthetic shape, but not stiffness or height, affects the maximum speed of sprinters with bilateral transtibial amputations

Running-specific prostheses (RSPs) have facilitated an athlete with bilateral transtibial amputations to compete in the Olympic Games. However, the performance effects of using RSPs compared to biological legs remains controversial. Further, the use of different prosthetic configurations such as shape, stiffness, and height likely influence performance. We determined the effects of using 15 different RSP configurations on the maximum speed of five male athletes with bilateral transtibial amputations. These athletes performed sets of running trials up to maximum speed using three different RSP models (Freedom Innovations Catapult FX6, Össur Flex-Foot Cheetah Xtend and Ottobock 1E90 Sprinter) each with five combinations of stiffness category and height. We measured ground reaction forces during each maximum speed trial to determine the biomechanical parameters associated with different RSP configurations and maximum sprinting speeds. Use of the J-shaped Cheetah Xtend and 1E90 Sprinter RSPs resulted in 8.3% and 8.0% (p<0.001) faster maximum speeds compared to the use of the C-shaped Catapult FX6 RSPs, respectively. Neither RSP stiffness expressed as a category (p = 0.836) nor as kN·m-1 (p = 0.916) affected maximum speed. Further, prosthetic height had no effect on maximum speed (p = 0.762). Faster maximum speeds were associated with reduced ground contact time, aerial time, and overall leg stiffness, as well as with greater stance-average vertical ground reaction force, contact length, and vertical stiffness (p = 0.015 for aerial time, p<0.001 for all other variables). RSP shape, but not stiffness or height, influences the maximum speed of athletes with bilateral transtibial amputations.

Prosthetic model, but not stiffness or height, affects maximum running velocity in athletes with unilateral transtibial amputations

The running-specific prosthetic (RSP) configuration used by athletes with transtibial amputations (TTAs) likely affects performance. Athletes with unilateral TTAs are prescribed C- or J-shaped RSPs with a manufacturer-recommended stiffness category based on body mass and activity level, and height based on unaffected leg and residual limb length. We determined how 15 different RSP model, stiffness, and height configurations affect maximum running velocity (v_max) and the underlying biomechanics. Ten athletes with unilateral TTAs ran at 3 m/s to v_max on a force-measuring treadmill. v_max was 3.8-10.7% faster when athletes used J-shaped versus C-shaped RSP models (p < 0.05), but was not affected by stiffness category, actual stiffness (kN/m), or height (p = 0.72, p = 0.37, and p = 0.11, respectively). v_max differences were explained by vertical ground reaction forces (vGRFs), stride kinematics, leg stiffness, and symmetry. While controlling for velocity, use of J-shaped versus C-shaped RSPs resulted in greater stance average vGRFs, slower step frequencies, and longer step lengths (p < 0.05). Stance average vGRFs were less asymmetric using J-shaped versus C-shaped RSPs (p < 0.05). Contact time and leg stiffness were more asymmetric using the RSP model that elicited the fastest v_max (p < 0.05). Thus, RSP geometry (J-shape versus C-shape), but not stiffness or height, affects v_max in athletes with unilateral TTAs.

Mechanisms to Attenuate Load in the Intact Limb of Transtibial Amputees When Performing a Unilateral Drop Landing

Individuals with unilateral transtibial amputations experience greater work demand and loading on the intact limb compared with the prosthetic limb, placing this limb at a greater risk of knee joint degenerative conditions. It is possible that increased loading on the intact side may occur due to strength deficits and joint absorption mechanics. This study investigated the intact limb mechanics utilized to attenuate load, independent of prosthetic limb contributions and requirements for forward progression, which could provide an indication of deficiencies in the intact limb. Amputee and healthy control participants completed 3 unilateral drop landings from a 30-cm drop height. Joint angles at touchdown; range of motion; coupling angles; peak powers; and negative work of the ankle, knee, and hip were extracted together with isometric quadriceps strength measures. No significant differences were found in the load or movement mechanics (P ≥ .31, g ≤ 0.42), despite deficits in isometric maximum (20%) and explosive (25%) strength (P ≤ .13, g ≥ 0.61) in the intact limb. These results demonstrate that, when the influence from the prosthetic limb and task demand are absent, and despite deficits in strength, the intact limb adopts joint mechanics similar to able-bodied controls to attenuate limb loading.

Comparison of Sprinting With and Without Running-Specific Prostheses Using Optimal Control Techniques

The purpose of our study was to get deeper insights into sprinting with and without running-specific prostheses and to perform a comparison of the two by combining analysis of known motion capture data with mathematical modeling and optimal control problem (OCP) findings. We established rigid multi-body system models with 14 bodies and 16 degrees of freedom in the sagittal plane for one unilateral transtibial amputee and three non-amputee sprinters. The internal joints are powered by torque actuators except for the passive prosthetic ankle joint which is equipped with a linear spring–damper system. For each model, the dynamics of one sprinting trial was reconstructed by solving a multiphase least squares OCP with discontinuities and constraints. We compared the motions of the amputee athlete and the non-amputee reference group by computing characteristic criteria such as the contribution of joint torques, the absolute mechanical work, step frequency and length, among others. By comparing the amputee athlete with the non-amputee athletes, we found reduced activity in the joints of the prosthetic limb, but increased torques and absolute mechanical work in the arms. We also compared the recorded motions to synthesized motions using different optimality criteria and found that the recorded motions are still far from the optimal solutions for both amputee and non-amputee sprinting.

Yank: the time derivative of force is an important biomechanical variable in sensorimotor systems

The derivative of force with respect to time does not have a standard term in physics. As a consequence, the quantity has been given a variety of names, the most closely related being 'rate of force development'. The lack of a proper name has made it difficult to understand how different structures and processes within the sensorimotor system respond to and shape the dynamics of force generation, which is critical for survival in many species. We advocate that ∂[Formula: see text]/∂t be termed 'yank', a term that has previously been informally used and never formally defined. Our aim in this Commentary is to establish the significance of yank in how biological motor systems are organized, evolve and adapt. Further, by defining the quantity in mathematical terms, several measurement variables that are commonly reported can be clarified and unified. In this Commentary, we first detail the many types of motor function that are affected by the magnitude of yank generation, especially those related to time-constrained activities. These activities include escape, prey capture and postural responses to perturbations. Next, we describe the multi-scale structures and processes of the musculoskeletal system that influence yank and can be modified to increase yank generation. Lastly, we highlight recent studies showing that yank is represented in the sensory feedback system, and discuss how this information is used to enhance postural stability and facilitate recovery from postural perturbations. Overall, we promote an increased consideration of yank in studying biological motor and sensory systems.

The Effect of Prosthetic Alignment on Prosthetic and Total Leg Stiffness While Running With Simulated Running-Specific Prostheses

Running-specific prostheses (RSP) are designed to replicate the spring-like behavior of the biological leg in people with a lower limb amputation. Running performance strongly depends on stiffness of the RSP. The aim of this study was to investigate the effects of angle of alignment of the RSP on its stiffness, and how this affects total leg stiffness and the gait pattern during running. Ten able-bodied athletes performed eight trials on a treadmill with running-specific prosthetic simulators, while the alignment of the blades relative to the socket was set in four different angles (0, 5, 10, and 15°) during two different step frequency conditions (free and imposed). RSP stiffness, total leg stiffness, residual leg stiffness, and spatiotemporal parameters were measured. In both step frequency conditions, the RSP stiffness decreased linearly with increasing angle of alignment. Able bodied athletes were able to compensate for the decreased RSP stiffness, and keep total leg stiffness almost invariant, by increasing residual leg stiffness through a more straight the knee at initial contact. This study confirms that alignment is an important factor to take into account when optimizing the RSP. Whether the observed compensations are feasible in amputee athletes needs further investigation.

Long jumpers with and without a transtibial amputation have different three-dimensional centre of mass and joint take-off step kinematics

Long jumpers with below the knee amputation (BKA) have achieved remarkable performances, yet the underlying biomechanics resulting in these jump distances are unknown. We measured three-dimensional motion and used multi-segment modelling to quantify and compare the centre of mass (COM) and joint kinematics of three long jumpers with BKA and seven non-amputee long jumpers during the take-off step of the long jump. Despite having the same jump distances, athletes with BKA, who used their affected leg for the take-off step, had lower sagittal plane hip and knee joint range of motion and positioned their affected leg more laterally relative to the COM compared to non-amputee athletes. Athletes with BKA had a longer compression phase and greater downward movement of their COM, suggesting that their affected leg (lever) was less rigid compared to the biological leg of non-amputees. Thus, athletes with BKA used a different kinematic mechanism to redirect horizontal to vertical velocity compared to non-amputee athletes. The specific movement patterns of athletes with BKA during the take-off step were constrained by the mechanical properties of the prosthesis. These results provide a basis for coaches and athletes to develop training protocols that improve performance and inform the design of future prostheses.

Vertical stiffness during one-legged hopping with and without using a running-specific prosthesis

Although athletes with unilateral below-the-knee amputations (BKAs) generally use their affected leg, including their prosthesis, as their take-off leg for the long jump, little is known about the spring-like leg behavior and stiffness regulation of the affected leg. The purpose of this study was to investigate vertical stiffness during one-legged hopping in an elite-level long jump athlete with a unilateral BKA. We used the spring-mass model to calculate vertical stiffness, which equals the ratio of maximum vertical ground reaction force to maximum center of mass displacement, while the athlete with a BKA hopped on one leg at a range of frequencies. Then, we compared the vertical stiffness of this athlete to seven non-amputee elite-level long-jumpers. We found that from 1.8 to 3.4 Hz, the vertical stiffness of the unaffected leg for an athlete with a BKA increases with faster hopping frequencies, but the vertical stiffness of the affected leg remains nearly constant across frequencies. The athlete with a BKA attained the desired hopping frequencies at 2.2 and 2.6 Hz, but was unable to match the lowest (1.8 Hz) and two highest frequencies (3.0 and 3.4 Hz) using his affected leg. We also found that at 2.5 Hz, unaffected leg vertical stiffness was 15% greater than affected leg vertical stiffness, and the vertical stiffness of non-amputee long-jumpers was 32% greater than the affected leg vertical stiffness of an athlete with a BKA. The results of the present study suggest that the vertical stiffness regulation strategy of an athlete with a unilateral BKA is not the same in the unaffected versus affected legs, and compared to non-amputees.

Joint moments during sprinting in unilateral transfemoral amputees wearing running-specific prostheses

Knowledge of joint moments will provide greater insight into the manner in which lower-extremity amputees wearing running-specific prostheses regain running capacity and compensate for replacement of an active leg with a passive prosthetic implement. Thus, the purpose of this study was to investigate three-dimensional joint moments during sprinting for unilateral transfemoral amputees wearing running-specific prostheses. Ten sprinters with unilateral transfemoral amputation performed maximal sprinting at the 22 m mark while wearing running-specific prostheses. Joint moments were calculated through an inverse dynamics approach. All peak flexion and extension moments in the prosthetic leg were found to be lower than those of the intact leg, except for the peak plantar flexion moment. In the frontal plane, the peak adduction and abduction moments in the prosthetic leg were generally lower than those of the intact leg. The peak internal rotation moments differed significantly between the legs, but the peak external rotation moments did not. The results of the present study suggest that asymmetric joint moment adaptations occur for unilateral transfemoral amputees to compensate for replacement of the biological leg with a passive prosthetic knee joint and running-specific prosthesis.

Summary: Asymmetric joint moment adaptations occur for unilateral transfemoral amputees to compensate for replacement of the biological leg with a passive prosthetic knee joint and running-specific prosthesis.

Athletes With Versus Without Leg Amputations: Different Biomechanics, Similar Running Economy

Athletes with transtibial amputations use carbon-fiber prostheses to run. Compared with biological legs, these devices differ in structure and function, and consequently yield affected leg running biomechanics that are theoretically more economical than those of nonamputees. However, experimental data indicate that athletes with unilateral and bilateral transtibial amputations exhibit running economy values that are well within the range of nonamputee values.

Three-Dimensional Takeoff Step Kinetics of Long Jumpers with and without a Transtibial Amputation

PURPOSE

The loads applied on the musculoskeletal system during the long jump takeoff step are not well established for nonamputee athletes or athletes with a lower extremity amputation. Information on joint loading and potential injury mechanisms is important for improving training or rehabilitation protocols, prosthetic design, and the general understanding of the long jump.

METHODS

Three-dimensional takeoff step kinematics and kinetics were used for inverse dynamic model calculations on three male athletes with and seven male athletes without a below the knee amputation (BKA). Athletes with BKA used their affected leg as their takeoff leg.

RESULTS

Despite equivalent long jump performance, ground reaction force application characteristics were widely different, and calculated joint loads were significantly lower in athletes with BKA compared with nonamputee athletes during the takeoff step. The takeoff step of the long jump for athletes with BKA seems to be dominated by sagittal plane movements, whereas it involves sagittal plane movement and compensatory joint work in the frontal plane for nonamputee athletes.

CONCLUSIONS

Coaches and athletes should adapt training protocols to the unique musculoskeletal loading patterns of long jumpers with or without a BKA. Specifically, nonamputee athletes should strengthen the muscles responsible for hip and knee extension, as well as for frontal plane stabilization, early in the season to avoid injuries. The presented data enable clinicians to identify potential causes of pain or injury more differentially in both groups of athletes and might stimulate future research in the field of robotics and prosthetic components. Furthermore, the altered joint mechanics of athletes with BKA versus nonamputees serves as an explanation for their previously described more effective takeoff step.

Running in highly cushioned shoes increases leg stiffness and amplifies impact loading

Running shoe cushioning has become a standard method for managing impact loading and consequent injuries due to running. However, despite decades of shoe technology developments and the fact that shoes have become increasingly cushioned, aimed to ease the impact on runners' legs, running injuries have not decreased. To better understand the shoe cushioning paradox, we examined impact loading and the spring-like mechanics of running in a conventional control running shoe and a highly cushioned maximalist shoe at two training speeds, 10 and 14.5 km/h. We found that highly cushioned maximalist shoes alter spring-like running mechanics and amplify rather than attenuate impact loading. This surprising outcome was more pronounced at fast running speed (14.5 km/h), where ground reaction force impact peak and loading rate were 10.7% and 12.3% greater, respectively, in the maximalist shoe compared to the conventional shoe, whereas only a slightly higher impact peak (6.4%) was found at the 10 km/h speed with the maximalist shoe. We attribute the greater impact loading with the maximalist shoes to stiffer leg during landing compared to that of running with the conventional shoes. These discoveries may explain why shoes with more cushioning do not protect against impact-related running injuries.

Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees

BACKGROUND

Dynamic Elastic Response prostheses are designed to absorb and return strain energy in running. Past research has focused on running prostheses with a single toe spring designed for high speeds.

RESEARCH QUESTION

To determine how runners with amputation modulate the ground reaction force of each limb to run at different speeds using a general-purpose dynamic prosthesis which has a heel spring.

METHODS

Overground running data were collected in 16 recreational runners (8 transtibial amputee using their own BladeXT prosthesis and 8 controls) using Vicon Nexus V.2.5 with Kistler force plates. Participants ran at self-selected running pace, 70% and 130% of that pace. Vertical, braking and propulsion peak ground reaction forces and impulses and vertical loading and decay rates were analysed between limbs at each speed (ANOVA) and their association with speed assessed (simple linear regression).

RESULTS

The vertical, braking forces and impulses and propulsive force were significantly less (p < 0.05) on the prosthetic limb than controls at the faster speed, but there was no difference in the propulsive impulse. The intact limb did not evidence increased vertical force at any speed, but experienced increased braking (p < 0.05) compared to both prosthetic limb and controls at the slow speed. For all limbs, braking and propulsive peak forces, decay rate, step length and step frequency were strongly (r > 0.6) and significantly (p < 0.05) associated with speed. On the prosthetic limb vertical impulse was strongly and significantly negatively associated with speed and control's braking impulse was associated with speed.

SIGNIFICANCE

A leg-specific response was found at different speeds. On the prosthetic limb the technique was to brake less not propel more at higher speeds with reduced vertical drive. Running at self-selected speed could be used for fitness without inducing detrimental ground reaction forces on the intact limb or evoking asymmetry in step length and frequency.

Case Study: A Bio-Inspired Control Algorithm for a Robotic Foot-Ankle Prosthesis Provides Adaptive Control of Level Walking and Stair Ascent

Powered ankle-foot prostheses assist users through plantarflexion during stance and dorsiflexion during swing. Provision of motor power permits faster preferred walking speeds than passive devices, but use of active motor power raises the issue of control. While several commercially available algorithms provide torque control for many intended activities and variations of terrain, control approaches typically exhibit no inherent adaptation. In contrast, muscles adapt instantaneously to changes in load without sensory feedback due to the intrinsic property that their stiffness changes with length and velocity. We previously developed a “winding filament” hypothesis (WFH) for muscle contraction that accounts for intrinsic muscle properties by incorporating the giant titin protein. The goals of this study were to develop a WFH-based control algorithm for a powered prosthesis and to test its robustness during level walking and stair ascent in a case study of two subjects with 4–5 years of experience using a powered prosthesis. In the WFH algorithm, ankle moments produced by virtual muscles are calculated based on muscle length and activation. Net ankle moment determines the current applied to the motor. Using this algorithm implemented in a BiOM T2 prosthesis, we tested subjects during level walking and stair ascent. During level walking at variable speeds, the WFH algorithm produced plantarflexion angles (range = −8 to −19°) and ankle moments (range = 1 to 1.5 Nm/kg) similar to those produced by the BiOM T2 stock controller and to people with no amputation. During stair ascent, the WFH algorithm produced plantarflexion angles (range −15 to −19°) that were similar to persons with no amputation and were ~5 times larger on average at 80 steps/min than those produced by the stock controller. This case study provides proof-of-concept that, by emulating muscle properties, the WFH algorithm provides robust, adaptive control of level walking at variable speed and stair ascent with minimal sensing and no change in parameters.

Sport-Specific Limb Prostheses in Para Sport

Prostheses form an essential part of participation in sport and physical activity for athletes with lower or upper limb amputation. These prostheses come in the form of everyday nonsport-specific prostheses, as well as sport-specific prostheses designed to enable participation in specific sports. Sport-specific prostheses are designed to the requirements of the sport to facilitate the achievement of peak performance without causing significant risk of injury. This article addresses the various factors associated with participation in sport and physical activity for individuals with amputation, including the various prostheses for upper and lower limbs and prostheses for different sports.

The biomechanics of the fastest sprinter with a unilateral transtibial amputation

People have debated whether athletes with transtibial amputations should compete with nonamputees in track events despite insufficient information regarding how the use of running-specific prostheses (RSPs) affect athletic performance. Thus, we sought to quantify the spatiotemporal variables, ground reaction forces, and spring-mass mechanics of the fastest athlete with a unilateral transtibial amputation using an RSP to reveal how he adapts his biomechanics to achieve elite running speeds. Accordingly, we measured ground reaction forces during treadmill running trials spanning 2.87 to 11.55 m/s of the current male International Paralympic Committee T44 100- and 200-m world record holder. To achieve faster running speeds, the present study’s athlete increased his affected leg (AL) step lengths ( P < 0.001) through longer contact lengths ( P < 0.001) and his unaffected leg (UL) step lengths ( P < 0.001) through longer contact lengths ( P < 0.001) and greater stance average vertical ground reaction forces ( P < 0.001). At faster running speeds, step time decreased for both legs ( P < 0.001) through shorter ground contact and aerial times ( P < 0.001). Unlike athletes with unilateral transtibial amputations, this athlete maintained constant AL and UL stiffness across running speeds ( P ≥ 0.569). Across speeds, AL step lengths were 8% longer ( P < 0.001) despite 16% lower AL stance average vertical ground reaction forces compared with the UL ( P < 0.001). The present study’s athlete exhibited biomechanics that differed from those of athletes with bilateral and without transtibial amputations. Overall, we present the biomechanics of the fastest athlete with a unilateral transtibial amputation, providing insight into the functional abilities of athletes with transtibial amputations using running-specific prostheses.

NEW & NOTEWORTHY The present study’s athlete achieved the fastest treadmill running trial ever attained by an individual with a leg amputation (11.55 m/s). From 2.87 to 11.55 m/s, the present study’s athlete maintained constant affected and unaffected leg stiffness, which is atypical for athletes with unilateral transtibial amputations. Furthermore, the asymmetric vertical ground reaction forces of athletes with unilateral transtibial amputations during running may be the result of leg length discrepancies.

Dynamic elastic response prostheses alter approach angles and ground reaction forces but not leg stiffness during a start-stop task

In a dynamic elastic response prosthesis (DERP), spring-like properties aim to replace the loss of musculature and soft tissues and optimise dynamic movement biomechanics, yet higher intact limb (IL) loading exists. It is unknown how amputees wearing a DERP will perform in start-stop movements and how altering the prosthetic stiffness will influence the performance and loading. This study assessed movement dynamics through comparisons in spatiotemporal, kinematic and kinetic variables and leg stiffness of intact, prosthetic and control limbs. The effect of prosthetic stiffness on movement dynamics was also determined. Eleven male unilateral transtibial amputees performed a start-stop task with one DERP set at two different stiffness - Prescribed and Stiffer. Eleven control participants performed the movement with the dominant limb. Kinematic and kinetic data were collected by a twelve-camera motion capture system synchronised with a Kistler force platform. Selected variables were compared between intact, prosthetic and control limbs, and against prosthetic stiffness using ANOVA and effect size. Pearson's Correlation was used to analyse relationship between leg stiffness and prosthetic deflection. Amputees showed a more horizontal approach to the bound during the start-stop movement, with lower horizontal velocities and a longer stance time on the IL compared to controls. In both stiffness conditions, the IL showed selected higher anteroposterior and vertical forces and impulses when compared to the controls. Leg stiffness was not significantly different between limbs as a result of the interplay between angle swept and magnitude of force, even with the change in prosthetic stiffness. A main effect for prosthetic stiffness was found only in higher impact forces of the prosthetic limb and more horizontal touchdown angles of the IL when using the prescribed DERP. In conclusion, amputees achieve the movement with a horizontal approach when compared to controls which may reflect difficulty of movement initiation with a DERP and a difficulty in performing the movement dynamically. The forces and impulses of the IL were high compared to control limbs. The consistent leg stiffness implies compensation strategies through other joints.

Ground Reaction Forces During Sprinting in Unilateral Transfemoral Amputees

Understanding the characteristics of ground reaction forces (GRFs) on both limbs during sprinting in unilateral amputees wearing running-specific prostheses would provide important information that could be utilized in the evaluation of athletic performance and development of training methods in this population. The purpose of this study was to compare GRFs between intact and prosthetic limbs during sprinting in unilateral transfemoral amputees wearing running-specific prostheses. Nine sprinters with unilateral transfemoral amputation wearing the same type of prosthesis performed maximal sprinting on a 40-m runway. GRFs were recorded from 7 force plates placed in the center of the runway. Peak forces and impulses of the GRFs in each direction were compared between limbs. Peak forces in vertical, braking, propulsive, and medial directions were significantly greater in intact limbs than those in prosthetic limbs, whereas there were no significant differences in peak lateral force between limbs. Further, significantly less braking impulses were observed in prosthetic limbs than in intact limbs; however, the other measured impulses were not different between limbs. Therefore, the results of the present study suggest that limb-specific rehabilitation and training strategies should be developed for transfemoral amputees wearing running-specific prostheses.

Elite long jumpers with below the knee prostheses approach the board slower, but take-off more effectively than non-amputee athletes

The use of technological aids to improve sport performance ('techno doping') and inclusion of Paralympic athletes in Olympic events are matters of ongoing debate. Recently, a long jumper with a below the knee amputation (BKA) achieved jump distances similar to world-class athletes without amputations, using a carbon fibre running-specific prosthesis (RSP). We show that athletes with BKA utilize a different, more effective take-off technique in the long jump, which provided the best athlete with BKA a performance advantage of at least 0.13 m compared to non-amputee athletes. A maximum speed constraint imposed by the use of RSPs would indicate a performance disadvantage for the long jump. We found slower maximum sprinting speeds in athletes with BKA, but did not find a difference in the overall vertical force from both legs of athletes with BKA compared to non-amputees. Slower speeds might originate from intrinsically lower sprinting abilities of athletes with BKA or from more complex adaptions in sprinting mechanics due to the biomechanical and morphological differences induced by RSPs. Our results suggest that due to different movement strategies, athletes with and without BKA should likely compete in separate categories for the long jump.

Leg stiffness during sprinting in transfemoral amputees with running-specific prosthesis

Carbon fiber running-specific prostheses are designed to reproduce the spring-like stepping behavior of individuals similar to springs loaded by the entire body mass (i.e. spring-mass model). The aim of this study was to test whether leg stiffness would be modulated differently between intact and prosthetic legs in transfemoral amputees wearing RSP during sprinting. Eight unilateral transfemoral amputees performed maximum sprinting along an indoor overground runway. Leg stiffness was calculated from kinetic and kinematic data in intact and prosthetic legs. The results showed that leg stiffness was for the prosthetic limb approximately 12% decreased compared to the intact limb. Although there was no difference in leg compression between the legs, maximal vertical ground reaction force was significantly greater in the intact leg than in the prosthetic one. These results indicate that asymmetric modulation of leg stiffness in transfemoral amputees with running-specific prostheses is mainly associated with asymmetric ground reaction force.

How do prosthetic stiffness, height and running speed affect the biomechanics of athletes with bilateral transtibial amputations?

Limited available information describes how running-specific prostheses and running speed affect the biomechanics of athletes with bilateral transtibial amputations. Accordingly, we quantified the effects of prosthetic stiffness, height and speed on the biomechanics of five athletes with bilateral transtibial amputations during treadmill running. Each athlete performed a set of running trials with 15 different prosthetic model, stiffness and height combinations. Each set of trials began with the athlete running on a force-measuring treadmill at 3 m s^-1, subsequent trials incremented by 1 m s^-1 until they achieved their fastest attainable speed. We collected ground reaction forces (GRFs) during each trial. Prosthetic stiffness, height and running speed each affected biomechanics. Specifically, with stiffer prostheses, athletes exhibited greater peak and stance average vertical GRFs (β = 0.03; p < 0.001), increased overall leg stiffness (β = 0.21; p < 0.001), decreased ground contact time (β = -0.07; p < 0.001) and increased step frequency (β = 0.042; p < 0.001). Prosthetic height inversely associated with step frequency (β = -0.021; p < 0.001). Running speed inversely associated with leg stiffness (β = -0.58; p < 0.001). Moreover, at faster running speeds, the effect of prosthetic stiffness and height on biomechanics was mitigated and unchanged, respectively. Thus, prosthetic stiffness, but not height, likely influences distance running performance more than sprinting performance for athletes with bilateral transtibial amputations.

Maximum-speed curve-running biomechanics of sprinters with and without unilateral leg amputations

On curves, non-amputees' maximum running speed is slower on smaller radii and thought to be limited by the inside leg's mechanics. Similar speed decreases would be expected for non-amputees in both counterclockwise and clockwise directions because they have symmetric legs. However, sprinters with unilateral leg amputation have asymmetric legs, which may differentially affect curve-running performance and Paralympic competitions. To investigate this and understand the biomechanical basis of curve running, we compared maximum curve-running (radius 17.2 m) performance and stride kinematics of six non-amputee sprinters and 11 sprinters with a transtibial amputation. Subjects performed randomized, counterbalanced trials: two straight, two counterclockwise curves and two clockwise curves. Non-amputees and sprinters with an amputation all ran slower on curves compared with straight running, but with different kinematics. Non-amputees ran 1.9% slower clockwise compared with counterclockwise (P<0.05). Sprinters with an amputation ran 3.9% slower with their affected leg on the inside compared with the outside of the curve (P<0.05). Non-amputees reduced stride length and frequency in both curve directions compared with straight running. Sprinters with an amputation also reduced stride length in both curve-running directions, but reduced stride frequency only on curves with the affected leg on the inside. During curve running, non-amputees and athletes with an amputation had longer contact times with their inside compared with their outside leg, suggesting that the inside leg limits performance. For sprinters with an amputation, the prolonged contact times of the affected versus unaffected leg seem to limit maximum running speed during both straight running and running on curves with the affected leg on the inside.

Characterisation of the responsive properties of two running-specific prosthetic models

BACKGROUND

The need for information regarding running-specific prosthetic properties has previously been voiced. Such information is necessary to assist in athletes' prostheses selection.

OBJECTIVES

This study aimed to describe the characteristics of two commercially available running-specific prostheses.

STUDY DESIGN

The running-specific prostheses were tested (in an experimental setup) without the external interference of athlete performance variations.

METHODS

Four stiffness categories of each running-specific prosthetic model (Xtend^™ and Xtreme^™) were tested at seven alignment setups and three drop masses (28, 38 and 48 kg). Results for peak ground reaction force (GRF_peak), contact time ( t_c), flight time ( t_f), reactive strength index (RSI) and maximal compression (Δ L) were determined during controlled dropping of running-specific prostheses onto a force platform with different masses attached to the experimental setup.

RESULTS

No statistically significant differences were found between the different setups of the running-specific prostheses. Statistically significant differences were found between the two models for all outcome variables (GRF_peak, Xtend > Xtreme; t_c, Xtreme > Xtend; t_f, Xtreme > Xtend; RSI, Xtend > Xtreme; Δ L, Xtreme > Xtend; p < 0.05).

CONCLUSION

These findings suggest that the Xtreme stores more elastic energy than the Xtend, leading to a greater performance response. The specific responsive features of blades could guide sprint athletes in their choice of running-specific prostheses. Clinical relevance Insights into the running-specific prosthesis (RSP) properties and an understanding of its responsive characteristics have implications for athletes' prosthetic choice. Physiologically and metabolically, a short sprint event (i.e. 100 m) places different demands on the athlete than a long sprint event (i.e. 400 m), and the RSP should match these performance demands.

Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations

Inspired by the springlike action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. However, manufacturer’s recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed 15 trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of 3 different prosthetic models (Freedom Innovations Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with 5 combinations of stiffness categories (manufacturer’s recommended and ± 1) and heights (International Paralympic Committee’s maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness [fixed effect (β) = 0.036; P = 0.008] but not height ( P ≥ 0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (in kilonewtons per meter), using the Flex-Run (β = −0.139; P = 0.044) and 1E90 Sprinter prostheses (β = −0.176; P = 0.009) reduced net metabolic costs by 4.3–4.9% compared with using the Catapult prostheses. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β = 2.786; P = 0.001), stride frequencies (β = 0.911; P < 0.001), and leg stiffness values (β = 0.053; P = 0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness but not height.

NEW & NOTEWORTHY We measured the metabolic rates and biomechanics of five athletes with bilateral transtibial amputations while running with different prosthetic configurations. The metabolic cost of running for these athletes is minimized by using an optimal prosthetic model and reducing prosthetic stiffness. The metabolic cost of running was independent of prosthetic height, suggesting that longer legs are not advantageous for distance running. Moreover, the in-series prosthetic stiffness governs the leg stiffness of athletes with bilateral leg amputations.

Prosthetic model, but not stiffness or height, affects the metabolic cost of running for athletes with unilateral transtibial amputations

Running-specific prostheses enable athletes with lower limb amputations to run by emulating the spring-like function of biological legs. Current prosthetic stiffness and height recommendations aim to mitigate kinematic asymmetries for athletes with unilateral transtibial amputations. However, it is unclear how different prosthetic configurations influence the biomechanics and metabolic cost of running. Consequently, we investigated how prosthetic model, stiffness, and height affect the biomechanics and metabolic cost of running. Ten athletes with unilateral transtibial amputations each performed 15 running trials at 2.5 or 3.0 m/s while we measured ground reaction forces and metabolic rates. Athletes ran using three different prosthetic models with five different stiffness category and height combinations per model. Use of an Ottobock 1E90 Sprinter prosthesis reduced metabolic cost by 4.3 and 3.4% compared with use of Freedom Innovations Catapult [fixed effect (β) = -0.177; P < 0.001] and Össur Flex-Run (β = -0.139; P = 0.002) prostheses, respectively. Neither prosthetic stiffness (P ≥ 0.180) nor height (P = 0.062) affected the metabolic cost of running. The metabolic cost of running was related to lower peak (β = 0.649; P = 0.001) and stance average (β = 0.772; P = 0.018) vertical ground reaction forces, prolonged ground contact times (β = -4.349; P = 0.012), and decreased leg stiffness (β = 0.071; P < 0.001) averaged from both legs. Metabolic cost was reduced with more symmetric peak vertical ground reaction forces (β = 0.007; P = 0.003) but was unrelated to stride kinematic symmetry (P ≥ 0.636). Therefore, prosthetic recommendations based on symmetric stride kinematics do not necessarily minimize the metabolic cost of running. Instead, an optimal prosthetic model, which improves overall biomechanics, minimizes the metabolic cost of running for athletes with unilateral transtibial amputations.NEW & NOTEWORTHY The metabolic cost of running for athletes with unilateral transtibial amputations depends on prosthetic model and is associated with lower peak and stance average vertical ground reaction forces, longer contact times, and reduced leg stiffness. Metabolic cost is unrelated to prosthetic stiffness, height, and stride kinematic symmetry. Unlike nonamputees who decrease leg stiffness with increased in-series surface stiffness, biological limb stiffness for athletes with unilateral transtibial amputations is positively correlated with increased in-series (prosthetic) stiffness.

Axial and torsional stiffness of pediatric prosthetic feet

BACKGROUND

Prosthetic stiffness likely affects the walking biomechanics of toddlers and children with leg amputations, but the actual stiffness values for prostheses are not reported by manufacturers or in standardized testing procedures.

AIM

We measured axial (k_A) and torsional (k_T) stiffness from four brands of pediatric prosthetic feet (Trulife, Kingsley Mfg. Co., TRS Incorporated, and College Park Industries) over a range of foot sizes.

METHODS

We applied forces and torques onto prostheses with a materials testing machine that replicated those exhibited in vivo by using the kinetics measured from four non-amputee toddlers (2-3years) during walking.

FINDINGS

Across brands, k_A averaged 35.2kN/m during heel loading, was more stiff during midfoot loading (121.8kN/m, P<0.001) and less stiff during forefoot loading (11.8kN/m, P=0.013). k_A was similar across brands with no statistically significant effect of prosthetic foot size, with the exception of the TRS feet. Plantarflexion torsional stiffness (k_T1), was not statistically different across brands. For every 1cm increase in foot size, k_T1 increased 0.16kN·m/rad (P<0.001). College Park prostheses had 4.54kN·m/rad lower dorsiflexion torsional stiffness (k_T2) (P<0.001) compared to other brands. For every 1cm increase in foot size, the k_T2 applied on the foot increased 0.63kN·m/rad.

INTERPRETATION

The axial and torsional stiffness testing methods are reproducible and should be adopted by prosthetic foot manufacturers. Axial and torsional stiffness values of commercially available prosthetic feet should be publically reported to health practitioners to ensure evidence-based decisions and meet the specific needs of each patient with a leg amputation.

A model for differential leg joint function during human running

Locomotion requires coordination of leg joints to maintain stability and to maneuver. We studied leg joint function during constant-average-velocity running and the sagittal-plane maneuvers of step ascent and descent. We tested two hypotheses: (1) that leg joints perform distinct functions during locomotion; and (2) that humans select functional parameters to maximize intrinsic dynamic stability. We recorded whole-body kinematics and forces when participants stepped up or down a single vertical step, and found that leg joints show functional differences during both constant-average-velocity locomotion and maneuvers. The hip, knee and ankle function as a motor, damper, and spring, respectively. We therefore constructed a simplified computational model of a human leg with a motor, damper, and spring in series (MDS). The intrinsic dynamics of the model resulted in sustained locomotion on level ground within narrow parameter ranges. However, using parameters experimentally derived from humans, the model showed only short-term stability. Humans may not optimize intrinsic dynamic stability alone, but may instead choose mechanical and behavioral parameters appropriate for both constant-average-velocity locomotion and maneuvers. Understanding joint-level mechanical function during unsteady locomotion helps to understand how differential joint function contributes to whole-body performance, and could lead to improvements in rehabilitation, prosthetic and robotic design.

Regulation of step frequency in transtibial amputee endurance athletes using a running-specific prosthesis

Running specific prostheses (RSP) are designed to replicate the spring-like behaviour of the human leg during running, by incorporating a real physical spring in the prosthesis. Leg stiffness is an important parameter in running as it is strongly related to step frequency and running economy. To be able to select a prosthesis that contributes to the required leg stiffness of the athlete, it needs to be known to what extent the behaviour of the prosthetic leg during running is dominated by the stiffness of the prosthesis or whether it can be regulated by adaptations of the residual joints. The aim of this study was to investigate whether and how athletes with an RSP could regulate leg stiffness during distance running at different step frequencies. Seven endurance runners with an unilateral transtibial amputation performed five running trials on a treadmill at a fixed speed, while different step frequencies were imposed (preferred step frequency (PSF) and -15%, -7.5%, +7.5% and +15% of PSF). Among others, step time, ground contact time, flight time, leg stiffness and joint kinetics were measured for both legs. In the intact leg, increasing step frequency was accompanied by a decrease in both contact and flight time, while in the prosthetic leg contact time remained constant and only flight time decreased. In accordance, leg stiffness increased in the intact leg, but not in the prosthetic leg. Although a substantial contribution of the residual leg to total leg stiffness was observed, this contribution did not change considerably with changing step frequency. Amputee athletes do not seem to be able to alter prosthetic leg stiffness to regulate step frequency during running. This invariant behaviour indicates that RSP stiffness has a large effect on total leg stiffness and therefore can have an important influence on running performance. Nevertheless, since prosthetic leg stiffness was considerably lower than stiffness of the RSP, compliance of the residual leg should not be ignored when selecting RSP stiffness.