Enhancement of walking for individuals with transfemoral and through-knee amputations: inverse and forward dynamic musculoskeletal approaches
File(s)
Author(s)
Benton, Alice
Type
Thesis or dissertation
Abstract
Reduced muscular capacity increases the demands on the residual musculoskeletal system in individuals with bilateral transfemoral (BTF), bilateral through-knee (BTK), unilateral transfemoral (UTF), and unilateral through-knee (UTK) limb loss, contributing to reduced walking endurance. Understanding muscle recruitment is critical for guiding rehabilitation strategies aimed at improving endurance and functionality. This thesis quantified muscle recruitment during walking using inverse dynamic musculoskeletal modelling, predicted gait modifications to reduce muscle demand through forward dynamic modelling, and tested these modifications using a biofeedback gait retraining system.
Two studies examined muscle recruitment during walking. The first involved individuals with BTF/BTK limb loss (n=6) and found elevated activation in flexor muscles of the residual limb. The second compared those with UTF limb loss (n=11) to able-bodied controls (n=11), identifying significantly greater hip flexor force, impulse, and activation in the residual limb (p ≤ 0.05), particularly in the iliacus and psoas major, indicating increased energy expenditure.
A third study introduced a forward dynamic musculoskeletal model, posed as an optimal control problem and solved via direct collocation. This model predicted gait modifications for individuals with UTF (n=3) and through-knee (n=1) amputations that reduced iliopsoas muscle demand. The most consistent modifications included decreased maximum hip extension, increased maximum hip flexion, and reduced step length.
A fourth study developed and evaluated two biofeedback systems providing audio-visual cues to promote these gait adjustments in individuals with UTF/UTK limb loss (n=6). While the systems successfully altered gait patterns in some cases, they did not consistently reduce iliopsoas recruitment. This suggests that changes in isolated kinematic features may be insufficient without broader gait adaptation.
Overall, this thesis provides insight the muscle recruitment of walking following lower-limb amputation and presents a methodological framework of modelling to experimental implementation which can be used guide future rehabilitation strategies.
Two studies examined muscle recruitment during walking. The first involved individuals with BTF/BTK limb loss (n=6) and found elevated activation in flexor muscles of the residual limb. The second compared those with UTF limb loss (n=11) to able-bodied controls (n=11), identifying significantly greater hip flexor force, impulse, and activation in the residual limb (p ≤ 0.05), particularly in the iliacus and psoas major, indicating increased energy expenditure.
A third study introduced a forward dynamic musculoskeletal model, posed as an optimal control problem and solved via direct collocation. This model predicted gait modifications for individuals with UTF (n=3) and through-knee (n=1) amputations that reduced iliopsoas muscle demand. The most consistent modifications included decreased maximum hip extension, increased maximum hip flexion, and reduced step length.
A fourth study developed and evaluated two biofeedback systems providing audio-visual cues to promote these gait adjustments in individuals with UTF/UTK limb loss (n=6). While the systems successfully altered gait patterns in some cases, they did not consistently reduce iliopsoas recruitment. This suggests that changes in isolated kinematic features may be insufficient without broader gait adaptation.
Overall, this thesis provides insight the muscle recruitment of walking following lower-limb amputation and presents a methodological framework of modelling to experimental implementation which can be used guide future rehabilitation strategies.
Date Issued
2024-12-30
Date Awarded
2025-06-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Bull, Anthony M J
Amiri, Pouya
Sponsor
Engineering and Physical Sciences Research Council
Grant Number
EP/S02249X/1
Publisher Department
Department of Bioengineering
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)