Restoration of Normative Postural Control

North Carolina State University

Status: Enrolling

Conditions: Lower Limb Amputation Below Knee (Injury)

Treatments: Behavioral: PT guided prosthetic training; Device: direct EMG controlled prosthetic ankle

Study type: Interventional

Funder types: Other

Identifiers

NCT06452186

26076

Details and patient eligibility

About

The objective of this proposal is to investigate the effects of training to use direct electromyographic (dEMG) control of a powered prosthetic ankle on transtibial amputees'.

The aimed questions to answer:

1. whether dEMG control will improve balance and postural stability of amputees,
2. whether dEMG control will lead to more natural neuromuscular control and coordination, 3) whether dEMG control will reduce cognitive processes.

Participants will go through PT guided training on using dEMG controlled prosthetic ankles and are evaluated for their capability on functional tasks.

The results will be compared with a comparison group, which goes through the same training but with their everyday passive prostheses on balance capability, neuromuscular coordination, and cognitive load during locomotion.

Full description

Lab Visit Experience for Participants with lower limb amputation:

• Number of Lab Visits: 15 visits. Clinicians may recommend skipping some of the visits or tasks based on clinical evaluation and status of the participants.

• Length of Lab Visit: three hours maximum

  1. First visit: the purpose of the first visit is to conduct consent and conduct measurements to decide walking speed and ABC (amputee balance confidence) score.
  2. Second visit: this visit is to ensure that the amputees' own socket system can be integrated into the powered prosthetic leg and validate the effectiveness of the EMG interface.
  3. Third and fourth visits: baseline evaluation with powered prosthesis and passive prosthesis. Each participant will finish the two visits. One of the visits is dedicated to their own passive prosthesis and the other visit is for the powered prosthesis. The sequence of the evaluation is randomized. The tasks conducted in the two visits are generally identical. The only difference is that one of the visits uses the participants' everyday prosthetic foot and the other uses the powered prosthetic ankle
  4. Fifth and sixth visits: these visits are dedicated to have the participants trained to regain muscle coordination, which is critical to use the powered prosthetic ankle. All the participants will go through these trainings. Based on whether the participants are selected as the powered prosthetic group (Group A) or the passive group (Group B), the participants will finish this training with the powered prosthetic leg or a passive prosthetic leg.
  5. Seven - eleventh visits: These visits are designed to give participants needed training, so participants are able to integrate the action of the powered prosthetic ankle with their full body motion for various tasks. To ensure that contribution of the training procedure to the performance changes are considered, all the participants will go through the training with the prostheses aligned with their group.
  6. Twelfth-thirteenth visit (duplicate of Third and fourth visit). These visits are used to evaluate the impact of the training program on the performance of the participants to conduct tasks which are not included in the training procedure. Each participant will conduct the task with both passive and powered prosthetic legs on different days.
  7. Fourteenth-fifteenth visits (duplicate of Third and fourth visit). These visits are used to understand the long term effects of the training program on the participants. These visits will be conducted three months after the 13th visits.

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 years or older;
• unilateral bower limb amputee
• K-level 2 or higher (who are frequent prosthesis users and may benefit from the proposed prosthesis training and use of dEMG controlled powered prosthesis)
• Amputation occurred over 2 years ago
• At least 1 year of experience using their prosthetic leg
• Has used the current socket for at least 6 months without a significant skin issue or major modification
• Are willing to come to NC State University's Centennial Campus to participate in research and be photographed while doing research activities

Exclusion criteria

• Have a very short residual shank (the length of the residual limb is ≤15% of the length of intact limb)
• Cannot perform functional ambulation in the community on a daily basis without assistive devices
• Cognitive or visual impairment that affects the participant's ability to provide informed consent or to follow simple instructions during the experiments
• Congenital amputees
• Amputees who use powered prosthetic ankles
• Weight more than 300lbs
• Pregnant Person
• Allergic to latex, which is often contained in medical tapes.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups

dEMG group

Experimental group

Description:

Patients go through the training procedure with the direct EMG controlled powered prosthetic ankle.

Treatment:

Device: direct EMG controlled prosthetic ankle

Behavioral: PT guided prosthetic training

Passive group

Active Comparator group

Description:

Patients go through the training procedure with their own passive prosthetic ankles

Treatment:

Behavioral: PT guided prosthetic training