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Research Papers

Muscle Function and Coordination of Amputee Stair Ascent

[+] Author and Article Information
Nicole G. Harper

Department of Mechanical Engineering,
The University of Texas at Austin,
204 E. Dean Keeton Street, Stop C2200,
Austin, TX 78712
e-mail: Nicole.harper@utexas.edu

Jason M. Wilken

Extremity Trauma and Amputation
Center of Excellence,
Center for the Intrepid,
Brooke Army Medical Center,
Ft. Sam, Houston, TX 78234;
Department of Physical Therapy
and Rehabilitation Science,
The University of Iowa,
1-252 Medical Education Building,
Iowa City, IA 52240
e-mail: jason-wilken@uiowa.edu

Richard R. Neptune

Department of Mechanical Engineering,
The University of Texas at Austin,
204 E. Dean Keeton Street, Stop C2200,
Austin, TX 78712
e-mail: rneptune@mail.utexas.edu

1Corresponding author.

Manuscript received November 23, 2017; final manuscript received June 22, 2018; published online September 25, 2018. Assoc. Editor: Tammy L. Haut Donahue.This work is in part a work of the U.S. Government. ASME disclaims all interest in the U.S. Government's contributions.

J Biomech Eng 140(12), 121004 (Sep 25, 2018) (10 pages) Paper No: BIO-17-1545; doi: 10.1115/1.4040772 History: Received November 23, 2017; Revised June 22, 2018

Ascending stairs is challenging following transtibial amputation due to the loss of the ankle muscles, which are critical to human movement. Efforts to improve stair ascent following amputation are hindered by the limited understanding of how the prosthesis and remaining muscles contribute to stair ascent. This study developed a three-dimensional (3D) muscle-actuated forward dynamics simulation of amputee stair ascent to identify the contributions of individual muscles and the passive prosthesis to the biomechanical subtasks of stair ascent. The prosthesis was found to provide vertical propulsion throughout stair ascent, similar to nonamputee plantarflexors. However, the timing differed considerably. The prosthesis also contributed to braking, similar to the nonamputee soleus, but to a greater extent. However, the prosthesis was unable to replicate the functions of nonamputee gastrocnemius, which contributes to forward propulsion during the second half of stance and leg swing initiation. To compensate, the hamstrings and vasti of the residual leg increased their contributions to forward propulsion during the first and second halves of stance, respectively. The prosthesis also contributed to medial control, consistent with the nonamputee soleus but not gastrocnemius. Therefore, prosthesis designs that provide additional vertical propulsion as well as forward propulsion, lateral control, and leg swing initiation at appropriate points in the gait cycle could improve amputee stair ascent. However, because nonamputee soleus and gastrocnemius contribute oppositely to many subtasks, it may be necessary to couple the prosthesis, which functions most similarly to soleus, with targeted rehabilitation programs focused on muscle groups that can compensate for gastrocnemius.

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References

Allen, J. L. , and Neptune, R. R. , 2012, “ Three-Dimensional Modular Control of Human Walking,” J. Biomech., 45(12), pp. 2157–2163. [CrossRef] [PubMed]
Pandy, M. G. , Lin, Y. C. , and Kim, H. J. , 2010, “ Muscle Coordination of Mediolateral Balance in Normal Walking,” J. Biomech., 43(11), pp. 2055–2064. [CrossRef] [PubMed]
Neptune, R. R. , Kautz, S. A. , and Zajac, F. E. , 2001, “ Contributions of the Individual Ankle Plantar Flexors to Support, Forward Progression and Swing Initiation During Walking,” J. Biomech., 34(11), pp. 1387–1398. [CrossRef] [PubMed]
Liu, M. Q. , Anderson, F. C. , Pandy, M. G. , and Delp, S. L. , 2006, “ Muscles That Support the Body Also Modulate Forward Progression During Walking,” J. Biomech., 39(14), pp. 2623–2630. [CrossRef] [PubMed]
Houdijk, H. , Pollmann, E. , Groenewold, M. , Wiggerts, H. , and Polomski, W. , 2009, “ The Energy Cost for the Step-to-Step Transition in Amputee Walking,” Gait Posture, 30(1), pp. 35–40. [CrossRef] [PubMed]
Genin, J. J. , Bastien, G. J. , Franck, B. , Detrembleur, C. , and Willems, P. A. , 2008, “ Effect of Speed on the Energy Cost of Walking in Unilateral Traumatic Lower Limb Amputees,” Eur. J. Appl. Physiol., 103(6), pp. 655–663. [CrossRef] [PubMed]
Prinsen, E. C. , Nederhand, M. J. , and Rietman, J. S. , 2011, “ Adaptation Strategies of the Lower Extremities of Patients With a Transtibial or Transfemoral Amputation During Level Walking: A Systematic Review,” Arch. Phys. Med. Rehabil., 92(8), pp. 1311–1325. [CrossRef] [PubMed]
Silverman, A. K. , and Neptune, R. R. , 2011, “ Differences in Whole-Body Angular Momentum Between Below-Knee Amputees and Non-Amputees Across Walking Speeds,” J. Biomech., 44(3), pp. 379–385. [CrossRef] [PubMed]
Sheehan, R. C. , Beltran, E. J. , Dingwell, J. B. , and Wilken, J. M. , 2015, “ Mediolateral Angular Momentum Changes in Persons With Amputation During Perturbed Walking,” Gait Posture, 41(3), pp. 795–800. [CrossRef] [PubMed]
Nadeau, S. , McFadyen, B. J. , and Malouin, F. , 2003, “ Frontal and Sagittal Plane Analyses of the Stair Climbing Task in Healthy Adults Aged Over 40 Years: What Are the Challenges Compared to Level Walking?,” Clin. Biomech., 18(10), pp. 950–959. [CrossRef]
DeVita, P. , Helseth, J. , and Hortobagyi, T. , 2007, “ Muscles Do More Positive Than Negative Work in Human Locomotion,” J. Exp. Biol., 210(Pt 19), pp. 3361–3373. [CrossRef] [PubMed]
Novak, A. C. , and Brouwer, B. , 2011, “ Sagittal and Frontal Lower Limb Joint Moments During Stair Ascent and Descent in Young and Older Adults,” Gait Posture, 33(1), pp. 54–60. [CrossRef] [PubMed]
Wilken, J. M. , Sinitski, E. H. , and Bagg, E. A. , 2011, “ The Role of Lower Extremity Joint Powers in Successful Stair Ambulation,” Gait Posture, 34(1), pp. 142–144. [CrossRef] [PubMed]
Powers, C. M. , Boyd, L. A. , Torburn, L. , and Perry, J. , 1997, “ Stair Ambulation in Persons With Transtibial Amputation: An Analysis of the Seattle LightFoot,” J. Rehabil. Res. Dev., 34(1), pp. 9–18. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.532.3911&rep=rep1&type=pdf [PubMed]
Schmalz, T. , Blumentritt, S. , and Marx, B. , 2007, “ Biomechanical Analysis of Stair Ambulation in Lower Limb Amputees,” Gait Posture, 25(2), pp. 267–278. [CrossRef] [PubMed]
Alimusaj, M. , Fradet, L. , Braatz, F. , Gerner, H. J. , and Wolf, S. I. , 2009, “ Kinematics and Kinetics With an Adaptive Ankle Foot System During Stair Ambulation of Transtibial Amputees,” Gait Posture, 30(3), pp. 356–363. [CrossRef] [PubMed]
Yack, J. H. , Nielsen, D. H. , and Shurr, D. G. , 1999, “ Kinetic Patterns During Stair Ascent in Patients With Transtibial Amputations Using Three Different Prostheses,” J. Prosthetics Orthotics, 11(3), pp. 57–62. [CrossRef]
Sinitski, E. H. , Hansen, A. H. , and Wilken, J. M. , 2012, “ Biomechanics of the Ankle-Foot System During Stair Ambulation: Implications for Design of Advanced Ankle-Foot Prostheses,” J. Biomech., 45(3), pp. 588–594. [CrossRef] [PubMed]
Agrawal, V. , Gailey, R. S. , Gaunaurd, I. A. , O'Toole, C. , and Finnieston, A. A. , 2013, “ Comparison Between Microprocessor-Controlled Ankle/Foot and Conventional Prosthetic Feet During Stair Negotiation in People With Unilateral Transtibial Amputation,” J. Rehabil. Res. Dev., 50(7), pp. 941–950. [CrossRef] [PubMed]
Torburn, L. , Schweiger, G. P. , Perry, J. , and Powers, C. M. , 1994, “ Below-Knee Amputee Gait in Stair Ambulation. A Comparison of Stride Characteristics Using Five Different Prosthetic Feet,” Clin. Orthop. Relat. Res., 303, pp. 185–192.
Aldridge, J. M. , Sturdy, J. T. , and Wilken, J. M. , 2012, “ Stair Ascent Kinematics and Kinetics With a Powered Lower Leg System Following Transtibial Amputation,” Gait Posture, 36(2), pp. 291–295. [CrossRef] [PubMed]
Zmitrewicz, R. J. , Neptune, R. R. , and Sasaki, K. , 2007, “ Mechanical Energetic Contributions From Individual Muscles and Elastic Prosthetic Feet During Symmetric Unilateral Transtibial Amputee Walking: A Theoretical Study,” J. Biomech., 40(8), pp. 1824–1831. [CrossRef] [PubMed]
Silverman, A. K. , and Neptune, R. R. , 2012, “ Muscle and Prosthesis Contributions to Amputee Walking Mechanics: A Modeling Study,” J. Biomech., 45(13), pp. 2271–2278. [CrossRef] [PubMed]
Harper, N. G. , Wilken, J. M. , and Neptune, R. R. , 2018, “ Muscle Function and Coordination of Stair Ascent,” ASME J. Biomech. Eng., 140(1), p. 011001. [CrossRef]
Lin, Y. C. , Fok, L. A. , Schache, A. G. , and Pandy, M. G. , 2015, “ Muscle Coordination of Support, Progression and Balance During Stair Ambulation,” J. Biomech., 48(2), pp. 340–347. [CrossRef] [PubMed]
Delp, S. L. , Loan, J. P. , Hoy, M. G. , Zajac, F. E. , Topp, E. L. , and Rosen, J. M. , 1990, “ An Interactive Graphics-Based Model of the Lower Extremity to Study Orthopaedic Surgical Procedures,” IEEE Trans. Biomed. Eng., 37(8), pp. 757–767. [CrossRef] [PubMed]
Davy, D. T. , and Audu, M. L. , 1987, “ A Dynamic Optimization Technique for Predicting Muscle Forces in the Swing Phase of Gait,” J. Biomech., 20(2), pp. 187–201. [CrossRef] [PubMed]
Neptune, R. R. , Wright, I. C. , and Van Den Bogert, A. J. , 2000, “ A Method for Numerical Simulation of Single Limb Ground Contact Events: Application to Heel-Toe Running,” Comput. Methods Biomech. Biomed. Eng., 3(4), pp. 321–334. [CrossRef]
Raasch, C. C. , Zajac, F. E. , Ma, B. , and Levine, W. S. , 1997, “ Muscle Coordination of Maximum-Speed Pedaling,” J. Biomech., 30(6), pp. 595–602. [CrossRef] [PubMed]
Winters, J. M. , and Stark, L. , 1988, “ Estimated Mechanical Properties of Synergistic Muscles Involved in Movements of a Variety of Human Joints,” J. Biomech., 21(12), pp. 1027–1041. [CrossRef] [PubMed]
Zajac, F. E. , 1989, “ Muscle and Tendon: Properties, Models, Scaling, and Application to Biomechanics and Motor Control,” Crit. Rev. Biomed. Eng., 17(4), pp. 359–411. http://e.guigon.free.fr/rsc/article/Zajac89.pdf [PubMed]
Goffe, W. L. , Ferrier, G. D. , and Rogers, J. , 1994, “ Global Optimization of Statistical Functions With Simulated Annealing,” J. Econometrics, 60(1–2), pp. 65–99. [CrossRef]
Neptune, R. R. , Sasaki, K. , and Kautz, S. A. , 2008, “ The Effect of Walking Speed on Muscle Function and Mechanical Energetics,” Gait Posture, 28(1), pp. 135–143. [CrossRef] [PubMed]
Neptune, R. R. , Zajac, F. E. , and Kautz, S. A. , 2004, “ Muscle Force Redistributes Segmental Power for Body Progression During Walking,” Gait Posture, 19(2), pp. 194–205. [CrossRef] [PubMed]
Lin, Y. C. , Kim, H. J. , and Pandy, M. G. , 2011, “ A Computationally Efficient Method for Assessing Muscle Function During Human Locomotion,” Int. J. Numer. Methods Biomed. Eng., 27(3), pp. 436–449. [CrossRef]
Anderson, F. C. , and Pandy, M. G. , 2003, “ Individual Muscle Contributions to Support in Normal Walking,” Gait Posture, 17(2), pp. 159–169. [CrossRef] [PubMed]
Della Croce, U. , and Bonato, P. , 2007, “ A Novel Design for an Instrumented Stairway,” J. Biomech., 40(3), pp. 702–704. [CrossRef] [PubMed]
Wilken, J. M. , Rodriguez, K. M. , Brawner, M. , and Darter, B. J. , 2012, “ Reliability and Minimal Detectible Change Values for Gait Kinematics and Kinetics in Healthy Adults,” Gait Posture, 35(2), pp. 301–307. [CrossRef] [PubMed]
Dempster, W. T. , 1955, “ Space Requirements of the Seated Operator: Geometrical, Kinematic, and Mechanical Aspects of the Body With Special Reference to the Limbs,” Wright Air Development Center Technical Report, Wright-Patterson Air Force Base, Dayton, OH.
Grood, E. S. , and Suntay, W. J. , 1983, “ A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee,” ASME J. Biomech. Eng., 105(2), pp. 136–144. [CrossRef]
Wu, G. , and Cavanagh, P. R. , 1995, “ ISB Recommendations for Standardization in the Reporting of Kinematic Data,” J. Biomech., 28(10), pp. 1257–1261. [CrossRef] [PubMed]
Wu, G. , Siegler, S. , Allard, P. , Kirtley, C. , Leardini, A. , Rosenbaum, D. , Whittle, M. , D'Lima, D. D. , Cristofolini, L. , Witte, H. , Schmid, O. , and Stokes, I. , 2002, “ ISB Recommendation on Definitions of Joint Coordinate System of Various Joints for the Reporting of Human Joint Motion—Part I: Ankle, Hip, and Spine,” J. Biomech., 35(4), pp. 543–548. [CrossRef] [PubMed]
Baker, R. , 2001, “ Pelvic Angles: A Mathematically Rigorous Definition Which Is Consistent With a Conventional Clinical Understanding of the Terms,” Gait Posture, 13(1), pp. 1–6. [CrossRef] [PubMed]
Ramstrand, N. , and Nilsson, K. A. , 2009, “ A Comparison of Foot Placement Strategies of Transtibial Amputees and Able-Bodied Subjects During Stair Ambulation,” Prosthetics Orthotics Int., 33(4), pp. 348–355. [CrossRef]
Kendell, C. , Lemaire, E. D. , Dudek, N. L. , and Kofman, J. , 2010, “ Indicators of Dynamic Stability in Transtibial Prosthesis Users,” Gait Posture, 31(3), pp. 375–379. [CrossRef] [PubMed]
Zajac, F. E. , and Gordon, M. E. , 1989, “ Determining Muscle's Force and Action in Multi-Articular Movement,” Exercise Sport Sci. Rev., 17(1), pp. 187–230. http://journals.lww.com/acsm-essr/Citation/1989/00170/Determining_Muscle_s_Force_and_Action_in.9.aspx
Zajac, F. E. , Neptune, R. R. , and Kautz, S. A. , 2002, “ Biomechanics and Muscle Coordination of Human Walking. Part I: Introduction to Concepts, Power Transfer, Dynamics and Simulations,” Gait Posture, 16(3), pp. 215–232. [CrossRef] [PubMed]
Silverman, A. K. , Fey, N. P. , Portillo, A. , Walden, J. G. , Bosker, G. , and Neptune, R. R. , 2008, “ Compensatory Mechanisms in Below-Knee Amputee Gait in Response to Increasing Steady-State Walking Speeds,” Gait Posture, 28(4), pp. 602–609. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

The six regions of the intact leg (dark shaded leg) gait cycle: (1) weight acceptance (intact foot-strike to residual toe-off), (2) pull-up and (3) forward continuance (residual toe-off to residual foot-strike divided into two equal regions), (4) push-up (residual foot-strike to intact toe-off), (5) early swing—foot clearance, and (6) late swing—foot placement (intact toe-off to intact foot-strike divided into two equal regions)

Grahic Jump Location
Fig. 2

Primary positive and negative contributors to vertical propulsion of the body COM (i.e., the vertical GRF impulse) during the two halves of residual and intact leg stance: (1) weight acceptance through pull-up, and (2) forward continuance through push-up. Muscle names without an asterisk (*) are from the leg specified in the plot title while muscle names with an asterisk (*) are from the contralateral leg. For muscle group abbreviations, see Table1.

Grahic Jump Location
Fig. 3

Musculotendon mechanical power output from the intact plantarflexors (gastrocnemius: GAS; soleus: SOL) and the prosthesis across the intact and residual leg gait cycles, respectively, and distributed to the trunk, intact leg and residual leg in the vertical direction. Positive (negative) net values indicate power generated (absorbed) by the musculotendon actuator. Positive (negative) values for the leg or trunk indicate that power is being generated to (absorbed from) the leg or trunk. The gray lines divide the gait cycle into three regions: (1) weight acceptance through pull-up, (2) forward continuance through push-up, and (3) swing (foot clearance through foot placement).

Grahic Jump Location
Fig. 4

Primary positive and negative contributors to AP propulsion of the body COM (i.e., the AP GRF impulse) during the two halves of intact and residual leg stance: (1) weight acceptance through pull-up, and (2) forward continuance through push-up. Positive (negative) GRF impulses indicate contributions to forward propulsion (braking) of the COM. Muscle names without an asterisk (*) are from the leg specified in the plot title while muscle names with an asterisk (*) are from the contralateral leg. For muscle group abbreviations, see Table 1.

Grahic Jump Location
Fig. 5

Musculotendon mechanical power output from the intact plantarflexors (gastrocnemius: GAS; soleus: SOL) and the prosthesis across the intact and residual leg gait cycles, respectively, and distributed to the trunk, intact leg and residual leg in the AP direction. Positive (negative) net values indicate power generated (absorbed) by the musculotendon actuator. Positive (negative) values for the leg or trunk indicate that power is being generated to (absorbed from) the leg or trunk. The gray lines divide the gait cycle into three regions: (1) weight acceptance through pull-up, (2) forward continuance through push-up, and (3) swing (foot clearance through foot placement).

Grahic Jump Location
Fig. 6

Primary positive and negative contributors to ML control of the body COM (i.e., the ML GRF impulse) during the two halves of intact and residual leg stance: (1) weight acceptance through pull-up, and (2) forward continuance through push-up. Positive (negative) GRF impulses indicate contributions to lateral (medial) control of the COM. Muscle names without an asterisk (*) are from the leg specified in the plot title while muscle names with an asterisk (*) are from the contralateral leg. For muscle group abbreviations, see Table1.

Grahic Jump Location
Fig. 7

Musculotendon mechanical power output from the intact plantarflexors (gastrocnemius: GAS; soleus: SOL) and the prosthesis across the intact and residual leg gait cycles, respectively, and distributed to the trunk, intact leg and residual leg in the ML direction. Positive (negative) net values indicate power generated (absorbed) by the musculotendon actuator. Positive (negative) values for the leg or trunk indicate that power is being generated to (absorbed from) the leg or trunk. The gray lines divide the gait cycle into three regions: (1) weight acceptance through pull-up, (2) forward continuance through push-up, and (3) swing (foot clearance through foot placement).

Grahic Jump Location
Fig. 8

Primary contributors to the net mean mechanical power generated (positive) to and absorbed (negative) from the intact and residual legs during: (1) swing initiation (push-up), (2) early swing (foot clearance), and (3) late swing (foot placement). Muscle names without an asterisk (*) are from the leg specified in the plot title while muscle names with an asterisk (*) are from the contralateral leg. For muscle group abbreviations, see Table 1.

Grahic Jump Location
Fig. 9

Musculotendon mechanical power output from the intact plantarflexors (gastrocnemius: GAS; soleus: SOL) and the prosthesis across the intact and residual leg gait cycles, respectively, and distributed to the trunk, intact leg and residual leg. Positive (negative) net values indicate power generated (absorbed) by the musculotendon actuator. Positive (negative) values for the leg or trunk indicate that power is being generated to (absorbed from) the leg or trunk. The gray lines divide the gait cycle into three regions: (1) weight acceptance through pull-up, (2) forward continuance through push-up, and (3) swing (foot clearance through foot placement).

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