Does Walking Performance Improve When Veterans With Leg Amputations Are Given Visual Feedback?

Completed

Conditions: Amputation

Registration Number: NCT03974945

Lead Sponsor: VA Office of Research and Development

Brief Summary: Previous studies suggest that Veterans with below the knee amputation using passive-elastic or powered prostheses have impaired physical function, which could increase the risk of osteoarthritis, leg/back pain, and diabetes/obesity. Utilization of rehabilitation strategies/techniques such as real-time visual feedback training could restore physical function, increase physical activity, and reduce injury risk. The investigators will systematically determine the effects of using real-time visual feedback training of peak propulsive (push-off) force during walking while Veterans with below the knee amputations use a passive-elastic and battery-powered prosthesis. Similar to previous studies of non-amputee older (\>65 years) and post-stroke adults, use of real-time visual feedback training of propulsive force will likely improve walking function in Veterans with amputations. Such training presents a promising rehabilitation strategy that could reduce comorbidities, while improving quality of life, comfort, and physical function, and advancing rehabilitation research and prosthetic development.

Detailed Description: Due to the functional impairments caused by a lower limb amputation, it is essential to determine the benefits of rehabilitation strategies such as real-time visual feedback training. Such training could allow Veterans with transtibial amputations (TTAs) to better utilize their prostheses and regain the greatest possible level of function. It is not clear how much the prosthetic device (passive-elastic prosthetic foot versus battery-powered ankle-foot prosthesis) and/or the user's response to the prosthesis contribute to the biomechanical and metabolic effects of using these prostheses during walking. Better use of a prosthesis due to targeted real-time visual feedback training could enhance rehabilitation, improve function and reduce asymmetric biomechanics, which in turn could reduce common comorbidities such as osteoarthritis, leg and back pain, and indirectly, diabetes in Veterans with TTAs. The purpose of the proposed project is to systematically establish the metabolic and biomechanical effects of targeted real-time visual feedback training of peak propulsive ground reaction force (GRF) on the biomechanics, metabolic costs, and muscle activity of Veterans with TTAs using their own passive-elastic prosthetic foot and a battery-powered ankle-foot prosthesis. The results of the investigators' research could enhance the use of prosthetic technology to improve the rehabilitation and function of Veterans with lower limb amputations.

Previous studies suggest that use of passive-elastic and/or powered ankle-foot prostheses may not optimize the function of Veterans with TTAs during walking. Targeted, real-time visual feedback training of peak propulsive ground reaction forces increased propulsion and improved walking function in older (\>65 years) and post-stroke adults, who typically have impaired ankle power. To the investigators' knowledge, no research has addressed how visual feedback of peak propulsive force affects the use of passive-elastic or powered ankle-foot prostheses by people with TTAs. In the proposed research, the investigators will determine the underlying metabolic costs, biomechanics, stability, and muscle activity resulting from targeted real-time visual feedback training of peak propulsive force to identify how Veterans with a TTA benefit from more effective use of a passive-elastic prosthesis and/or a battery-powered ankle-foot prosthesis and to determine if the addition of mechanical power provided by a battery-powered ankle-foot prosthesis can further enhance the function of Veterans with unilateral TTAs during walking. 30 Veterans with unilateral TTAs will use their own passive-elastic prosthesis both with and without visual feedback training during level-ground walking, while the investigators measure their metabolic costs and biomechanics. Then, they will use a powered ankle-foot prosthesis (emPOWER, BiONX, Ottobock) both with and without visual feedback training during level-ground walking, while the investigators measure their metabolic costs and biomechanics. With each prosthesis, subjects will walk at 1.25 m/s on a dual-belt force-measuring treadmill 1) with no visual feedback, and then with real-time visual feedback of: 2) peak propulsive force from the "no feedback" condition, 3) +20% greater peak propulsive force, and 4) +40% greater peak propulsive force. During these visual feedback trials, the investigators will ask subjects to match the peak propulsive force displayed on a computer screen with their affected leg. The investigators will also ask subjects to: 5) match symmetric visual feedback of the peak propulsive force from both legs. The investigators will determine if Veterans with TTAs utilizing real-time visual feedback training of peak propulsive force can improve metabolic costs, biomechanical symmetry, and dynamic stability/balance, while using their own passive-elastic prosthesis or a powered ankle-foot prosthesis. The investigators will also establish if Veterans with TTAs can retain the metabolic and biomechanical benefits elicited by real-time visual feedback training once that feedback is removed. Results from the proposed project will be used to inform rehabilitation strategies and prosthetic design, which could ultimately improve health, maximize function, and improve quality of life for Veterans with TTAs.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 12

Inclusion Criteria

One amputation below the knee
At least 1 year of experience using a prosthesis
No current problems with the prosthesis or residual limb
At or above a K3 Medicare Functional Classification Level

Exclusion Criteria

Poor general health
Difficulty with mobility
Problems with balance or dizziness
Current serious musculoskeletal injury besides that associated with an amputation
Cardiovascular, pulmonary, or neurological disease or disorder

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Affected Leg Peak Propulsive Horizontal Ground Reaction Force	18 trials that are 5 minutes in length	The investigators measured peak propulsive horizontal ground reaction force (hGRFpeak) from the affected leg while participants with a transtibial amputation walked at 1.25 m/s for 18 trials that were 5 minutes each over 3 separate days using an elastic energy storage and return (ESAR) and stance-phase powered ankle-foot (BiOM) prosthesis. During the first trial we measured their baseline hGRFpeak and then for the subsequent trials we provided a trial with visual feedback (FB) targets of hGRFpeak relative to their baseline (BL) trial using a monitor placed at eye level as well as VF of symmetric (Sym) targets of hGRFpeak from both legs and then removed the visual feedback during a retention (RT) trial that immediately followed the VF trial. The order of trials was randomized and included targets of 0, +20, and +40% of baseline hGRFpeak as well as a Sym target of hGRFpeak. Thus, participants performed 9 trials per prosthesis.
Trailing Affected Leg Positive Work	18 trials that are 5 minutes in length	The investigators measured ground reaction forces and calculated individual leg work during step to step transitions while participants with a transtibial amputation walked at 1.25 m/s for 18 trials that were 5 minutes each over 3 separate days using an elastic energy storage and return (ESAR) and stance-phase powered ankle-foot (BiOM) prosthesis. During the first trial we measured their baseline peak propulsive horizontal ground reaction force (hGRFpeak) from the affected leg and then for the subsequent trials we provided a trial with visual feedback (FB) targets of hGRFpeak relative to their baseline (BL) trial using a monitor placed at eye level as well as VF of symmetric (Sym) targets of hGRFpeak from both legs and then removed the visual feedback during a retention (RT) trial that immediately followed the VF trial. The order of trials was randomized and included targets of 0, +20, and +40% of baseline hGRFpeak as well as a Sym target of hGRFpeak.
Net Metabolic Power	18 trials that are 5 minutes in length	The investigators measured net metabolic power while participants with a transtibial amputation walked at 1.25 m/s for 18 trials that were 5 minutes each over 3 separate days using an elastic energy storage and return (ESAR) and stance-phase powered ankle-foot (BiOM) prosthesis. During the first trial we measured their baseline peak propulsive horizontal ground reaction force (hGRFpeak) from the affected leg and then for the subsequent trials we provided a trial with visual feedback (FB) targets of hGRFpeak relative to their baseline (BL) trial using a monitor placed at eye level as well as VF of symmetric (Sym) targets of hGRFpeak from both legs and then removed the visual feedback during a retention (RT) trial that immediately followed the VF trial. The order of trials was randomized and included targets of 0, +20, and +40% of baseline hGRFpeak as well as a Sym target of hGRFpeak. Thus, participants performed 9 trials per prosthesis.
Leading Unaffected Leg Negative Work	18 trials that are 5 minutes in length	The investigators measured ground reaction forces and calculated individual leg work during step to step transitions while participants with a transtibial amputation walked at 1.25 m/s for 18 trials that were 5 minutes each over 3 separate days using an elastic energy storage and return (ESAR) and stance-phase powered ankle-foot (BiOM) prosthesis. During the first trial we measured their baseline peak propulsive horizontal ground reaction force (hGRFpeak) from the affected leg and then for the subsequent trials we provided a trial with visual feedback (FB) targets of hGRFpeak relative to their baseline (BL) trial using a monitor placed at eye level as well as VF of symmetric (Sym) targets of hGRFpeak from both legs and then removed the visual feedback during a retention (RT) trial that immediately followed the VF trial. The order of trials was randomized and included targets of 0, +20, and +40% of baseline hGRFpeak as well as a Sym target of hGRFpeak.

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (1): Rocky Mountain Regional VA Medical Center, Aurora, CO
🇺🇸
Aurora, Colorado, United States
Rocky Mountain Regional VA Medical Center, Aurora, CO
🇺🇸Aurora, Colorado, United States