Outdoor Overground Gait Biomechanics and Energetics in Individuals With Transtibial Amputation Walking With a Prescribed Passive Prosthesis and a Bionic Myoelectric Prosthesis.

The metabolic cost of walking for individuals with transtibial amputation is generally greater compared with able-bodied individuals. One aim of powered prostheses is to reduce metabolic deficits by replicating biological ankle function. Individuals with transtibial amputation can activate their residual limb muscles to volitionally control bionic ankle prostheses for walking; however, it is unknown how myoelectric control performs outside the laboratory. We recruited 6 individuals with transtibial amputation to walk an outdoor course with the Open Source Leg prosthesis under continuous proportional myoelectric control and compared it with their passive device. There were no significant differences (P = .142) in cost of transport between prostheses. Participants significantly increased residual limb vastus lateralis (P = .042) and rectus femoris (P = .029) muscle activity during early and midstance phase of walking with the powered prosthesis compared with their passive device. All but one participant preferred walking with myoelectric control compared with their passive prosthesis. The additional mass of the powered ankle prosthesis coupled with increased residual quadriceps activity could explain why the energy cost of walking was not lower compared with a passive prosthesis. This study demonstrates participants can volitionally control a bionic ankle prosthesis to navigate real-world environments.