Unilateral trans-femoral amputee gait consumes up to 60% more energy than able-bodied gait. For higher level amputees, research suggests that energy efficiency drops by well over 80%. Recently it has been shown that energy consumption in high level amputees increases significantly when walking on slopes, suggesting studies in level walking may underestimate the extent of the problem. The negative effects of high energy consumption are compounded by reductions in walking speed of typically 40% for trans-femoral amputees with associated low activity levels, particularly in elderly amputees. These deficits are even greater in bilateral amputees. This has a tremendous impact on what amputees can achieve and the consequences for their quality of life.
The energy storage and return capabilities of prostheses are crucial to improving the situation and yet modern prostheses only store and return significant energy below the knee, and energy is not returned in a controlled manner. For example, stored energy is not available for plantar-flexion (push-off) at the end of stance. Furthermore, modern prosthetic systems don't transfer energy between joints, which is a lost opportunity as, for example, the excess of eccentric work at the knee could be stored and used in a controlled manner at other joints. For these reasons, we believe there is an opportunity for truly transformative research leading to a step change in the performance of lower limb prostheses.
We have been undertaking simulation studies to establish the potential for hydraulic technology to enable controlled storage, transfer between joints, and return of energy in lower limb prostheses. This work is showing great promise and we have held back from publishing our results because of the possibility of protecting the intellectual property rights. Although the work to date has focussed on prostheses for trans-tibial amputees, this approach has even greater potential for improving the energy efficiency of trans-femoral amputee gait. Therefore, in this project, we will explore storage, transfer between joints, and return of energy involving ankle, knee and hip; the latter to evaluate the potential for amputees to benefit from some additional energy storage and return via a hip orthosis.
To achieve our objectives we will build on our research in three areas, which correspond to the three main work packages (WPs). WP1 will develop and simulate alternative concept designs. WP2 will establish a methodology for predicting the ways in which amputees might adapt their gait to alternative prostheses. WP3 will provide gait laboratory data for: validating the gait prediction methodology; and informing the concept designs.