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Hu M, Kobayashi T, Hisano G, Murata H, Ichimura D, Hobara H. Sprinting performance of individuals with unilateral transfemoral amputation: compensation strategies for lower limb coordination. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221198. [PMID: 36908994 PMCID: PMC9993038 DOI: 10.1098/rsos.221198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Understanding the sprinting patterns of individuals with unilateral transfemoral amputation (uTFA) is important for designing improved running-specific prostheses and for prosthetic gait rehabilitation. Continuous relative phase (CRP) analysis acquires clues from movement kinematics and obtains insights into the sprinting coordination of individuals with uTFA. Seven individuals with uTFA sprinted on a 40 m runway. The spatio-temporal parameters, joint and segment angles of the lower limbs were obtained, and CRP analysis was performed on thigh-shank and shank-foot couplings. Subsequently, the asymmetry ratios of the parameters were calculated. Statistical analyses were performed between the lower limbs. Significant differences in the stance time, stance phase percentage, ankle joint angles and CRP of the shank-foot coupling (p < 0.05) were observed between the lower limbs. The primary contributor to these differences could be the structural differences between the lower limbs. Despite the presence of different coordination features in the stance and swing phases between the lower limbs, no significant difference in the coordination patterns of the thigh-shank coupling was observed. This may be a compensation strategy for achieving coordination patterns with improved symmetry between the lower limbs. The results of this study provide novel insights into the sprinting movement patterns of individuals with uTFA.
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Affiliation(s)
- Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Genki Hisano
- Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo 152-8550, Japan
- Research Fellow of Japan Society for the Promotion of Science (JSPS), Tokyo 102-0083, Japan
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0014, Japan
| | - Hiroto Murata
- Department of Mechanical Engineering, Tokyo University of Science, Chiba 278-8510, Japan
| | - Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0014, Japan
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo 125-8585, Japan
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Barnett CT, De Asha AR, Skervin TK, Buckley JG, Foster RJ. Spring-mass behavioural adaptations to acute changes in prosthetic blade stiffness during submaximal running in unilateral transtibial prosthesis users. Gait Posture 2022; 98:153-159. [PMID: 36126535 DOI: 10.1016/j.gaitpost.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/20/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- C T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, UK.
| | - A R De Asha
- School of Science and Technology, Nottingham Trent University, Nottingham, UK; C-Motion, Inc., Germantown, MD, USA
| | - T K Skervin
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J G Buckley
- Department of Biomedical & Electronics Engineering, University of Bradford, Bradford, UK
| | - R J Foster
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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Tacca JR, Beck ON, Taboga P, Grabowski AM. Running-specific prosthesis model, stiffness and height affect biomechanics and asymmetry of athletes with unilateral leg amputations across speeds. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211691. [PMID: 35706678 PMCID: PMC9156922 DOI: 10.1098/rsos.211691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/04/2022] [Indexed: 05/03/2023]
Abstract
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 (Lc ), 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 Lc (p = 2.69 × 10-7) and F avg asymmetry (p = 0.032); the effect on Lc 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 Lc asymmetry (p ≤ 0.00033); this effect was independent of speed (p ≥ 0.071). The use of a shorter RSP decreased Lc (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.
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Affiliation(s)
- Joshua R. Tacca
- Paul M. Rady Department of Mechanical Engineering, University of Colorado, Boulder, CO, USA
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Owen N. Beck
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Paolo Taboga
- Department of Kinesiology, Sacramento State University, Sacramento, CA, USA
| | - Alena M. Grabowski
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, CO, USA
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Hadj-Moussa F, Ngan CC, Andrysek J. Biomechanical factors affecting individuals with lower limb amputations running using running-specific prostheses: A systematic review. Gait Posture 2022; 92:83-95. [PMID: 34837772 DOI: 10.1016/j.gaitpost.2021.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 10/10/2021] [Accepted: 10/28/2021] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Firdous Hadj-Moussa
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Calvin C Ngan
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada
| | - Jan Andrysek
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada.
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Added lower limb mass does not affect biomechanical asymmetry but increases metabolic power in runners with a unilateral transtibial amputation. Eur J Appl Physiol 2020; 120:1449-1456. [DOI: 10.1007/s00421-020-04367-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/05/2020] [Indexed: 11/26/2022]
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Beck ON, Grabowski AM. Athletes With Versus Without Leg Amputations: Different Biomechanics, Similar Running Economy. Exerc Sport Sci Rev 2019; 47:15-21. [PMID: 30334850 DOI: 10.1249/jes.0000000000000174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Owen N Beck
- The George W. Woodruff School of Mechanical Engineering, and.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Alena M Grabowski
- Department of Integrative Physiology, University of Colorado, Boulder.,Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, CO
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Napier C, MacLean CL, Maurer J, Taunton JE, Hunt MA. Kinetic risk factors of running-related injuries in female recreational runners. Scand J Med Sci Sports 2018; 28:2164-2172. [DOI: 10.1111/sms.13228] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. Napier
- Department of Physical Therapy; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
- Fortius Lab; Fortius Institute; Burnaby BC Canada
| | - C. L. MacLean
- Department of Physical Therapy; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
- Fortius Lab; Fortius Institute; Burnaby BC Canada
| | - J. Maurer
- Fortius Lab; Fortius Institute; Burnaby BC Canada
| | - J. E. Taunton
- Fortius Lab; Fortius Institute; Burnaby BC Canada
- Division of Sports Medicine; Department of Family Practice; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - M. A. Hunt
- Department of Physical Therapy; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
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Abstract
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.
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Affiliation(s)
- Lara Grobler
- Institute of Sport and Exercise Medicine, Faculty of Health and Medical Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa; Department of Sport Science, Faculty of Education, Stellenbosch University, Suidwal Street, Coetzenburg, Stellenbosch 7600, South Africa.
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Health and Medical Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Liew BX, Morris S, Masters A, Netto K. A comparison and update of direct kinematic-kinetic models of leg stiffness in human running. J Biomech 2017; 64:253-257. [DOI: 10.1016/j.jbiomech.2017.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/09/2017] [Accepted: 09/25/2017] [Indexed: 11/15/2022]
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Beck ON, Taboga P, Grabowski AM. Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations. J Appl Physiol (1985) 2017; 122:976-984. [PMID: 28104752 DOI: 10.1152/japplphysiol.00587.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/15/2016] [Accepted: 01/12/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Owen N. Beck
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado; and
| | - Paolo Taboga
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado; and
| | - Alena M. Grabowski
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado; and
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, Colorado
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Beck ON, Taboga P, Grabowski AM. Prosthetic model, but not stiffness or height, affects the metabolic cost of running for athletes with unilateral transtibial amputations. J Appl Physiol (1985) 2017; 123:38-48. [PMID: 28360121 DOI: 10.1152/japplphysiol.00896.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Owen N Beck
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado; and
| | - Paolo Taboga
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado; and
| | - Alena M Grabowski
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado; and.,Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, Colorado
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Characterizing the Mechanical Properties of Running-Specific Prostheses. PLoS One 2016; 11:e0168298. [PMID: 27973573 PMCID: PMC5156386 DOI: 10.1371/journal.pone.0168298] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022] Open
Abstract
The mechanical stiffness of running-specific prostheses likely affects the functional abilities of athletes with leg amputations. However, each prosthetic manufacturer recommends prostheses based on subjective stiffness categories rather than performance based metrics. The actual mechanical stiffness values of running-specific prostheses (i.e. kN/m) are unknown. Consequently, we sought to characterize and disseminate the stiffness values of running-specific prostheses so that researchers, clinicians, and athletes can objectively evaluate prosthetic function. We characterized the stiffness values of 55 running-specific prostheses across various models, stiffness categories, and heights using forces and angles representative of those measured from athletes with transtibial amputations during running. Characterizing prosthetic force-displacement profiles with a 2nd degree polynomial explained 4.4% more of the variance than a linear function (p<0.001). The prosthetic stiffness values of manufacturer recommended stiffness categories varied between prosthetic models (p<0.001). Also, prosthetic stiffness was 10% to 39% less at angles typical of running 3 m/s and 6 m/s (10°-25°) compared to neutral (0°) (p<0.001). Furthermore, prosthetic stiffness was inversely related to height in J-shaped (p<0.001), but not C-shaped, prostheses. Running-specific prostheses should be tested under the demands of the respective activity in order to derive relevant characterizations of stiffness and function. In all, our results indicate that when athletes with leg amputations alter prosthetic model, height, and/or sagittal plane alignment, their prosthetic stiffness profiles also change; therefore variations in comfort, performance, etc. may be indirectly due to altered stiffness.
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