Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2019

Open Access 01-12-2019 | Research

The effects of ankle stiffness on mechanics and energetics of walking with added loads: a prosthetic emulator study

Authors: Erica A. Hedrick, Philippe Malcolm, Jason M. Wilken, Kota Z. Takahashi

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2019

Login to get access

Abstract

Background

The human ankle joint has an influential role in the regulation of the mechanics and energetics of gait. The human ankle can modulate its joint ‘quasi-stiffness’ (ratio of plantarflexion moment to dorsiflexion displacement) in response to various locomotor tasks (e.g., load carriage). However, the direct effect of ankle stiffness on metabolic energy cost during various tasks is not fully understood. The purpose of this study was to determine how net metabolic energy cost was affected by ankle stiffness while walking under different force demands (i.e., with and without additional load).

Methods

Individuals simulated an amputation by using an immobilizer boot with a robotic ankle-foot prosthesis emulator. The prosthetic emulator was controlled to follow five ankle stiffness conditions, based on literature values of human ankle quasi-stiffness. Individuals walked with these five ankle stiffness settings, with and without carrying additional load of approximately 30% of body mass (i.e., ten total trials).

Results

Within the range of stiffness we tested, the highest stiffness minimized metabolic cost for both load conditions, including a ~ 3% decrease in metabolic cost for an increase in stiffness of about 0.0480 Nm/deg/kg during normal (no load) walking. Furthermore, the highest stiffness produced the least amount of prosthetic ankle-foot positive work, with a difference of ~ 0.04 J/kg from the highest to lowest stiffness condition. Ipsilateral hip positive work did not significantly change across the no load condition but was minimized at the highest stiffness for the additional load conditions. For the additional load conditions, the hip work followed a similar trend as the metabolic cost, suggesting that reducing positive hip work can lower metabolic cost.

Conclusion

While ankle stiffness affected the metabolic cost for both load conditions, we found no significant interaction effect between stiffness and load. This may suggest that the importance of the human ankle’s ability to change stiffness during different load carrying tasks may not be driven to minimize metabolic cost. A prosthetic design that can modulate ankle stiffness when transitioning from one locomotor task to another could be valuable, but its importance likely involves factors beyond optimizing metabolic cost.
Appendix
Available only for authorised users
Literature
1.
Neptune RR, Kautz SA, Zajac FE. Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking. J Biomech. 2001;34(11):1387–98.CrossRefPubMed
2.
Huang TP, Shorter KA, Adamczyk PG, Kuo AD. Mechanical and energetic consequences of reduced ankle plantar-flexion in human walking. J Exp Biol. 2015;218(22):3541–50.CrossRefPubMedPubMedCentral
3.
Zelik KE, Kuo AD. Human walking isn’t all hard work: evidence of soft tissue contributions to energy dissipation and return. J Exp Biol. 2010;213(24):4257–64.CrossRefPubMedPubMedCentral
4.
DeVita P, Hortobagyi T. Age causes a redistribution of joint torques and powers during gait. J Appl Physiol. 2000;88(5):1804–11.CrossRefPubMed
5.
Nadeau S, Gravel D, Arsenault AB, Bourbonnais D. Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Clin Biomech. 1999;14(2):125–35.CrossRef
6.
Fey NP, Klute GK, Neptune RR. The influence of energy storage and return foot stiffness on walking mechanics and muscle activity in below-knee amputees. Clin Biomech. 2011;26(10):1025–32.CrossRef
7.
Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Gait Posture. 1999;9(3):207–31.CrossRefPubMed
8.
Sadeghi H, Allard P, Duhaime M. Muscle power compensatory mechanisms in below-knee amputee gait. Am J Phys Med Rehabil. 2001;80(1):25–32.CrossRefPubMed
9.
Russell Esposito E, Whitehead JMA, Wilken JM. Step-to-step transition work during level and inclined walking using passive and powered ankle-foot prostheses. Prosthetics Orthot Int. 2016;40(3):311–9.CrossRef
10.
Houdijk H, Pollmann E, Groenewold M, Wiggerts H, Polomski W. The energy cost for the step-to-step transition in amputee walking. Gait Posture. 2009;30(1):35–40.CrossRefPubMed
11.
Schmalz T. Blumentritt S, Jarasch R. energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components. Gait Posture. 2002;16:255–63.CrossRefPubMed
12.
Hansen AH, Childress DS, Miff SC, Gard SA, Mesplay KP. The human ankle during walking: implications for design of biomimetic ankle prostheses. J Biomech. 2004;37(10):1467–74.CrossRefPubMed
13.
Shamaei K, Sawicki GS, Dollar AM. Estimation of Quasi-Stiffness and Propulsive Work of the Human Ankle in the Stance Phase of Walking. PLoS One. 2013;8(3).
14.
Safaeepour Z, Esteki A, Ghomshe FT, Abu Osman NA. Quantitative analysis of human ankle characteristics at different gait phases and speeds for utilizing in ankle-foot prosthetic design. Biomed Eng Online. 2014;13(1):1–8.CrossRef
15.
Major MJ, Twiste M, Kenney LPJ, Howard D. The effects of prosthetic ankle stiffness on ankle and knee kinematics, prosthetic limb loading, and net metabolic cost of trans-tibial amputee gait. Clin Biomech. 2014;29(1):98–104.CrossRef
16.
Shell CE, Segal AD, Klute GK, Neptune RR. The effects of prosthetic foot stiffness on transtibial amputee walking mechanics and balance control during turning. Clin Biomech. 2017;49(August):56–63.CrossRef
17.
Collins JD, Arch ES, Crenshaw JR, Bernhardt KA, Khosla S, Amin S, et al. Net ankle quasi-stiffness is influenced by walking speed but not age for older adult women. Gait Posture. 2018;62:311–6.CrossRefPubMedPubMedCentral
18.
Shamaei K, Cenciarini M, Dollar AM. On the mechanics of the knee during the stance phase of the gait On the Mechanics of the Knee during the Stance Phase of the Gait. In: 33rd Annual International Conference of the IEEE EMBS. 2011. p. 8135–8140.
19.
Argunsah Bayram H, Bayram MB. Dynamic functional stiffness index of the ankle joint during daily living. J Foot Ankle Surg. 2018;57(4):668–74.CrossRefPubMed
20.
Kern AM, Papachatzis N, Patterson JM, Bruening DA, Takahashi KZ. Ankle and midtarsal joint quasi-stiffness during walking with added mass. PeerJ. 2019;7:7:e7487.
21.
22.
Adamczyk PG, Roland M, Hahn ME. Sensitivity of biomechanical outcomes to independent variations of hindfoot and forefoot stiffness in foot prostheses. Hum Mov Sci. 2017;54(April):154–71.CrossRefPubMedPubMedCentral
23.
Fey NP, Klute GK, Neptune RR. Altering prosthetic foot stiffness influences foot and muscle function during below-knee amputee walking: a modeling and simulation analysis. J Biomech. 2013;46(4):637–44.CrossRefPubMed
24.
Zelik KE, Collins SH, Adamczyk PG, Segal AD, Klute GK, Morgenroth DC, et al. Systematic variation of prosthetic foot spring affects center-of-mass mechanics and metabolic cost during walking. IEEE Trans Neural Syst Rehabil Eng. 2011;19(4):411–9.CrossRefPubMedPubMedCentral
25.
Doyle SS, Lemaire ED, Besemann M, Dudek NL. Changes to level ground transtibial amputee gait with a weighted backpack. Clin Biomech. 2014;29(2):149–54.CrossRef
26.
Schnall BL, Wolf EJ, Bell JC, Gambel J, Bensel CK. Metabolic analysis of male servicemembers with transtibial amputations carrying military loads. J Rehabil Res Dev. 2012;49(4):535–44.CrossRefPubMed
27.
Shepherd MK, Rouse EJ. The VSPA foot a quasi-passive ankle-foot. IEEE Trans Neural Syst Rehabil Eng. 2017;25(12):2375–86.CrossRefPubMed
28.
Glanzer EM, Adamczyk PG. Design and validation of a semi-active variable stiffness foot prosthesis. IEEE Trans Neural Syst Rehabil Eng. 2018;26(12):2351–9.CrossRefPubMedPubMedCentral
29.
30.
Adamczyk PG, Collins SH, Kuo AD. The advantages of a rolling foot in human walking. J Exp Biol. 2006;209(20):3953–63.CrossRefPubMed
31.
Caputo JM, Collins SH. Prosthetic ankle push-off work reduces metabolic rate but not collision work in non-amputee walking. Sci Rep. 2014;4:37–41.
32.
33.
Malcolm P, Quesada RE, Caputo JM, Collins SH. The influence of push-off timing in a robotic ankle-foot prosthesis on the energetics and mechanics of walking. J Neuroeng Rehabil. 2015;12(1).
34.
Mager F, Richards J, Hennies M, Dotzel E, Chohan A, Mbuli A, et al. Determination of ankle and metatarsophalangeal stiffness during walking and jogging. J Appl Biomech. 2018;34(6):448–53.CrossRef
35.
Quesada RE, Caputo JM, Collins SH. Increasing ankle push-off work with a powered prosthesis does not necessarily reduce metabolic rate for transtibial amputees. J Biomech. 2016;49(14):3452–9.CrossRefPubMed
36.
Grenier JG, Peyrot N, Castells J, Oullion R, Messonnier L, Morin JB. Energy cost and mechanical work of walking during load carriage in soldiers. Med Sci Sports Exerc. 2012;44(6):1131–40.CrossRefPubMed
37.
Griffin TM, Roberts TJ, Kram R. Metabolic cost of generating muscular force in human walking: insights from load-carrying and speed experiments. J Appl Physiol. 2003;95(1):172–83.CrossRefPubMed
38.
Wilken JM, Rodriguez KM, Brawner M, Darter BJ. Reliability and minimal detectible change values for gait kinematics and kinetics in healthy adults. Gait Posture. 2012;35(2):301–7.CrossRefPubMed
39.
Crouter SE, Antczak A, Hudak JR, DellaValle DM, Haas JD. Accuracy and reliability of the ParvoMedics TrueOne 2400 and MedGraphics VO2000 metabolic systems. Eur J Appl Physiol. 2006;98(2):139–51.CrossRefPubMed
40.
Brockway JM. Derivation of formulae used to calculate energy expenditure in man. Hum Nutr Clin Nutr. 1987;41(6):463–71.PubMed
41.
Takahashi KZ, Gross MT, Van Werkhoven H, Piazza SJ, Sawicki GS. Adding stiffness to the foot modulates soleus force-velocity behaviour during human walking. Sci Rep. 2016;6:29870.CrossRefPubMedPubMedCentral
42.
Zelik KE, Takahashi KZ, Sawicki GS. Six degree-of-freedom analysis of hip, knee, ankle and foot provides updated understanding of biomechanical work during human walking. J Exp Biol. 2015;218(6):876–86.CrossRefPubMed
43.
Buczek FL, Kepple TM, Siegel KL, Stanhope SJ. Translational and rotational joint power terms in a six degree-of-freedom model of the normal ankle complex. J Biomech. 1994;27(12):1447–57.CrossRefPubMed
44.
Takahashi KZ, Kepple TM, Stanhope SJ. A unified deformable (UD) segment model for quantifying total power of anatomical and prosthetic below-knee structures during stance in gait. J Biomech. 2012;45(15):2662–7.CrossRefPubMed
45.
46.
Takahashi KZ, Worster K, Bruening DA. Energy neutral: the human foot and ankle subsections combine to produce near zero net mechanical work during walking. Sci Rep. 2017;7(1):1–9.CrossRef
47.
Takahashi KZ, Stanhope SJ. Mechanical energy profiles of the combined ankle-foot system in normal gait: insights for prosthetic designs. Gait Posture. 2013;38(4):818–23.CrossRefPubMed
48.
Rolian C, Lieberman DE, Hamill J, Scott JW, Werbel W. Walking, running and the evolution of short toes in humans. J Exp Biol. 2009;212(5):713–21.CrossRefPubMed
49.
Ker RF, Bennett MB, Bibby SR, Kester RC, Alexander RM. The spring in the arch of the human foot. Nature. 1987;325(6100):147–9.CrossRefPubMed
50.
MacWilliams BA, Cowley M, Nicholson DE. Foot kinematics and kinetics during adolescent gait. Gait Posture. 2003;3:214–24.CrossRef
51.
Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. Proc Natl Acad Sci. 2019;116(5):1645–50.CrossRefPubMedPubMedCentral
52.
Honert EC, Bastas G, Zelik KE. Effect of toe joint stiffness and toe shape on walking biomechanics. Bioinspiration and Biomimetics. 2018;13(6):aadf46.
53.
Davidson A, Gardinier ES, Gates DH. Within and between-day reliability of energetic cost measures during treadmill walking. Cogent Eng. 2016;3:1251028.CrossRef
54.
Young AJ, Gannon H, Ferris DP. A biomechanical comparison of proportional electromyography control to biological torque control using a powered hip exoskeleton. Front Bioeng Biotechnol. 2017;5:37.CrossRefPubMedPubMedCentral
55.
Young AJ, Foss J, Gannon H, Ferris DP. Influence of power delivery timing on the energetics and biomechanics of humans wearing a hip exoskeleton. Front Bioeng Biotechnol. 2017;5:1–11.
56.
Zhang J, Fiers P, Witte KA, Jackson RW, Poggensee KL, Atkeson CG, et al. Human-in-the-loop optimiziation of exoskeleton assistance during walking. Sci Robot. 2017;356:1280–4.
57.
Ding Y, Kim M, Kuindersma S, Walsh CJ. Human-in-the-loop optimization of hip assistance with a soft exosuit during walking. Sci Robot. 2018;3(15):1–9.CrossRef
58.
Ingraham KA, Choi H, Gardinier ES, Remy CD, Gates DH. Choosing appropriate prosthetic ankle work to reduce the metabolic cost of individuals with transtibial amputation. Sci Rep. 2018;8(1):1–12.CrossRef
59.
Koller JR, Jacobs DA, Ferris DP, Remy CD. Learning to walk with an adaptive gain proportional myoelectric controller for a robotic ankle exoskeleton. J Neuroeng Rehabil. 2015;12(1):1–14.CrossRef
60.
Panizzolo FA, Freisinger GM, Karavas N, Eckert-Erdheim AM, Siviy C, Long A, et al. Metabolic cost adaptations during training with a soft exosuit assisting the hip joint. Sci Rep. 2019;9(1):1–10.CrossRef
Metadata
Title
The effects of ankle stiffness on mechanics and energetics of walking with added loads: a prosthetic emulator study
Authors
Erica A. Hedrick
Philippe Malcolm
Jason M. Wilken
Kota Z. Takahashi
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2019
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/s12984-019-0621-x

Other articles of this Issue 1/2019

Journal of NeuroEngineering and Rehabilitation 1/2019 Go to the issue

Research

Tarsal fusion for pes equinovarus deformity improves gait capacity in chronic stroke patients

Research

Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study

Research

Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study

Research

The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

Research

Adapting myoelectric control in real-time using a virtual environment

Research

Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot