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Individuals with Unilateral Transtibial Amputation and Lower Activity Levels Walk More Quickly when Using a Hydraulically Articulating Versus Rigidly Attached Prosthetic Ankle-Foot Device

Barnett, Cleveland T., PhD; Brown, Olivia H., M Eng; Bisele, Maria, M Eng; Brown, Marcus J., M Eng; De Asha, Alan R., PhD; Strutzenberger, Gerda, PhD

JPO: Journal of Prosthetics and Orthotics: July 2018 - Volume 30 - Issue 3 - p 158–164
doi: 10.1097/JPO.0000000000000179

Introduction Prosthetic ankle-foot devices incorporating a hydraulic articulation between the pylon and prosthetic foot have been shown to be beneficial to the gait of more active individuals with unilateral transtibial amputation (UTA). However, the functional benefits of using hydraulic ankle-foot devices to less active individuals with UTA are yet to be determined. The aim of the current study was to investigate the effects on gait performance of using a non-energy-storage-and-return foot with a hydraulic attachment compared with an identical rigidly attached foot during overground walking in less active individuals with UTA.

Materials and Methods Kinematic and kinetic data were recorded while five individuals with UTA, deemed K2 activity level by their prescribing physician, performed two-minute walk tests (2MWTs) and 10 overground gait trials in two conditions: using a hydraulically articulating ankle-foot device (HYD) and using a rigidly attached ankle-foot device (RIG).

Results Walking speed during the 2MWT was increased by 6.5% on average in the HYD (1.07 m/second) condition compared with the RIG (1.01 m/second) condition (Cohen d = 0.4). Participants displayed more symmetrical interlimb loading (d = 0.8), increased minimum forward center of pressure velocity (d = 0.8), increased peak shank rotational velocity (d = 1.0), and decreased prosthetic energy efficiency (d = 0.7) when using the HYD compared with the RIG device.

Conclusions Individuals with lower activity levels walk faster and therefore further when using a foot with a hydraulically articulating attachment in comparison with a rigid attachment. A reduced braking effect in early stance phase as a result of the action of the hydraulic component present in the articulating attachment partially explains the improvement in walking performance.

CLEVELAND T. BARNETT, PhD, OLIVIA H. BROWN, M Eng, and MARIA BISELE, M Eng, are affiliated with the School of Science and Technology, Nottingham Trent University, UK.

MARCUS J. BROWN, M Eng, is affiliated with HAS Motion Inc, Kingston, ON, Canada.

ALAN R. DE ASHA, PhD, is affiliated with C-Motion, Inc, Germantown, Maryland.

GERDA STRUTZENBERGER, PhD, is affiliated with the Department of Sport Science and Kinesiology, University of Salzburg, Hallein-Rif, Austria.

Disclosure: The authors declare no conflict of interest.

Correspondence to: Cleveland T. Barnett, PhD, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS; email:

© 2018 by the American Academy of Orthotists and Prosthetists.