Patient-Preferred Prosthetic Ankle-Foot Alignment for Ramps and Level-Ground Walking

Patient preference of lower limb prosthesis behavior informally guides clinical decision making, and may become increasingly important for tuning new robotic prostheses. However, the processes for quantifying preference are still being developed, and the strengths and weaknesses of preference are not adequately understood. The present study sought to characterize the reliability (consistency) of patient preference of alignment during level-ground walking, and determine the patient-preferred ankle angle for ascent and descent of a 10° ramp, with implications for the design and control of robotic prostheses. Seven subjects with transtibial amputation walked over level ground, and ascended and descended a 10° ramp on a semi-active prosthetic ankle capable of unweighted repositioning in dorsiflexion and plantarflexion. Preferred ankle angle was measured with an adaptive forced-choice psychophysics paradigm, in which subjects walked on a randomized static ankle angle and reported whether they would prefer the ankle to be dorsiflexed or plantarflexed. Subjects had reliable preferences for alignment during level-ground walking, with deviations of 1.5° from preference resulting in an 84% response rate preferring changes toward the preference. Relative to level walking, subjects preferred 7.8° (SD: 4.8°) of dorsiflexion during ramp ascent, and 5.3° (SD: 3.8°) plantarflexion during ramp descent. As the ankle angle better matched the ramp angle, socket pressures and tibial progression (shank pitch) both more closely mirrored those during level walking. These findings provide baseline behaviors for prosthetic ankles capable of adapting to slopes based on patient preference, and provide strong evidence that people with transtibial amputation can finely perceive ankle alignment.