File
Coker K1, Davis Z2, Morris J2, Pratt M2, Scarborough T2
1Tennessee State University, Nashville, United States, 2Tennessee State University, Physical Therapy, Nashville, United States
Background: Transtibial prosthetic designs have evolved over time with ankle components initially being rigid and static. Flexible components and now bionic components are available. Prosthetic ankle components vary in their ability to mimic a biological limb especially in regards to metabolic energy and in gait efficiency.
Purpose: The purpose of this review was three-fold: first to evaluate the strength and quality of the current research evidence on the use of powered plantar prosthetics, second, to determine whether current evidence regarding the use of bionic prosthetics should be considered when making decisions regarding functionality and efficiency of gait; and third, to identify weaknesses in the current evidence and area for continued research.
Methods: Systematic review methods: A literature search was performed on databases including: IEEE Xplore, Science Direct, IOP Science, PLOS one, Google scholar, Wiley, EBSCO Host, and PubMed. Keywords used in the search include: powered prosthesis, trans-tibial amputation, metabolic cost, proprioception, EMG, and walking economy. The searches were completed in June 2017 through February 2018. Articles selected for review were those of original research performed since 2003 and were evaluated for quality using the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence system.
Results: A total of 31 sources were reviewed for this study. Two sources were included in the introduction. Four articles examined the current practices for preventing gait abnormalities based on prosthetic design; two studies looked at the biomechanics of healthy lower extremities while another two investigated the biomechanics of prosthetic gait. Studies on gait speed including three articles on using bionic components, five articles on the comparison of bionic components to passive components using electromyography (EMG), and two studies which used metabolic demands as means of gait efficiency.
Conclusion(s): Three bionic designs emerged: intrinsic powered plantar flexion, EMG regulated plantar flexion and a combination integrating both intrinsic algorithms and EMG regulation to control the prosthetic. Of the three types of designs, evidence suggests the intrinsic algorithms with EMG extrinsic regulation is the most functional and efficient for transtibial prosthetic gait. The EMG controlled prosthetics are less reliable for functional gait on varying surfaces, higher probability for abnormal gait deviations, and minimal assistance with metabolic demands.
Implications: Physical therapists perform prosthetic gait evaluations and recommend prosthetic components for maximum efficiency and functionality. Current research supports individuals with trans-tibial amputations that use powered plantar prosthetics are more functional and efficient in ambulation than passive prosthetics.
Keywords: powered prosthesis, trans-tibial amputation, metabolic cost
Funding acknowledgements: No funding sources were utilized.
Purpose: The purpose of this review was three-fold: first to evaluate the strength and quality of the current research evidence on the use of powered plantar prosthetics, second, to determine whether current evidence regarding the use of bionic prosthetics should be considered when making decisions regarding functionality and efficiency of gait; and third, to identify weaknesses in the current evidence and area for continued research.
Methods: Systematic review methods: A literature search was performed on databases including: IEEE Xplore, Science Direct, IOP Science, PLOS one, Google scholar, Wiley, EBSCO Host, and PubMed. Keywords used in the search include: powered prosthesis, trans-tibial amputation, metabolic cost, proprioception, EMG, and walking economy. The searches were completed in June 2017 through February 2018. Articles selected for review were those of original research performed since 2003 and were evaluated for quality using the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence system.
Results: A total of 31 sources were reviewed for this study. Two sources were included in the introduction. Four articles examined the current practices for preventing gait abnormalities based on prosthetic design; two studies looked at the biomechanics of healthy lower extremities while another two investigated the biomechanics of prosthetic gait. Studies on gait speed including three articles on using bionic components, five articles on the comparison of bionic components to passive components using electromyography (EMG), and two studies which used metabolic demands as means of gait efficiency.
Conclusion(s): Three bionic designs emerged: intrinsic powered plantar flexion, EMG regulated plantar flexion and a combination integrating both intrinsic algorithms and EMG regulation to control the prosthetic. Of the three types of designs, evidence suggests the intrinsic algorithms with EMG extrinsic regulation is the most functional and efficient for transtibial prosthetic gait. The EMG controlled prosthetics are less reliable for functional gait on varying surfaces, higher probability for abnormal gait deviations, and minimal assistance with metabolic demands.
Implications: Physical therapists perform prosthetic gait evaluations and recommend prosthetic components for maximum efficiency and functionality. Current research supports individuals with trans-tibial amputations that use powered plantar prosthetics are more functional and efficient in ambulation than passive prosthetics.
Keywords: powered prosthesis, trans-tibial amputation, metabolic cost
Funding acknowledgements: No funding sources were utilized.
Topic: Robotics & technology; Human movement analysis
Ethics approval required: No
Institution: Tennessee State University
Ethics committee: Department of Physical Therapy Ethics Committee
Reason not required: This systematic review did involve human subjects.
All authors, affiliations and abstracts have been published as submitted.
