Improving Amputee Endurance over Activities of Daily Living with a Robotic Knee-Ankle Prosthesis: A Case Study.

Robotic knee-ankle prostheses have often fallen short relative to passive microprocessor prostheses in time-based clinical outcome tests. User ambulation endurance is an alternative clinical outcome metric that may better highlight the benefits of robotic prostheses. However, previous studies were unable to show endurance benefits due to inaccurate high-level classification, discretized mid-level control, and insufficiently difficult ambulation tasks. In this case study, we present a phase-based mid-level prosthesis controller which yields biomimetic joint kinematics and kinetics that adjust to suit a continuum of tasks. We enrolled an individual with an above-knee amputation and challenged him to perform repeated, rapid laps of a circuit comprising activities of daily living with both his passive prosthesis and a robotic prosthesis. The participant demonstrated improved endurance with the robotic prosthesis and our mid-level controller compared to his passive prosthesis, completing over twice as many total laps before fatigue and muscle discomfort required him to stop. We also show that time-based outcome metrics fail to capture this endurance improvement, suggesting that alternative metrics related to endurance and fatigue may better highlight the clinical benefits of robotic prostheses.