Choosing appropriate prosthetic ankle work to reduce the metabolic cost of individuals with transtibial amputation

Powered ankle prostheses have been designed to reduce the energetic burden that individuals with transtibial amputation experience during ambulation. There is an open question regarding how much power the prosthesis should provide, and whether approximating biological ankle kinetics is optimal to reduce the metabolic cost of users. We tested 10 individuals with transtibial amputation walking on a treadmill wearing the BiOM powered ankle prosthesis programmed with 6 different power settings (0–100%), including a prosthetist-chosen setting, chosen to approximate biological ankle kinetics. We measured subjects’ metabolic cost of transport (COT) and the BiOM’s net ankle work during each condition. Across participants, power settings greater than 50% resulted in lower COT than 0% or 25%. The relationship between power setting, COT, and net ankle work varied considerably between subjects, possibly due to individual adaptation and exploitation of the BiOM’s reflexive controller. For all subjects, the best tested power setting was higher than the prosthetist-chosen setting, resulting in a statistically significant and meaningful difference in COT between the best tested and prosthetist-chosen power settings. The results of this study demonstrate that individuals with transtibial amputation may benefit from prescribed prosthetic ankle push-off work that exceeds biological norms.