# Can Sensory Feedback Training Improve the Biomechanical and Metabolic Effects of Using Passive or Powered Lower Limb Prostheses During Walking for Veterans with Transtibial Amputations?

> **NIH VA I01** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2024 · —

## Abstract

[Due to the functional impairments caused by a lower limb amputation, it is essential to determine the
benefits of rehabilitation strategies such as real-time visual feedback training. Such training could allow
Veterans with transtibial amputations (TTAs) to better utilize their prostheses and regain the greatest possible
level of function. It is not clear how much the prosthetic device (passive-elastic prosthetic foot versus battery-
powered ankle-foot prosthesis) and/or the user’s response to the prosthesis contribute to the biomechanical
and metabolic effects of using these prostheses during walking. Better use of a prosthesis due to targeted real-
time visual feedback training could enhance rehabilitation, improve function and reduce asymmetric
biomechanics, which in turn could reduce common comorbidities such as osteoarthritis, leg and back pain, and
indirectly, diabetes in Veterans with TTAs. The purpose of the proposed project is to systematically establish
the metabolic and biomechanical effects of targeted real-time visual feedback training of peak propulsive
ground reaction force (GRF) on the biomechanics, metabolic costs, and muscle activity of Veterans with TTAs
using their own passive-elastic prosthetic foot and a battery-powered ankle-foot prosthesis. The results of our
research could enhance the use of prosthetic technology to improve the rehabilitation and function of Veterans
with lower limb amputations.
 Previous studies suggest that use of passive-elastic and/or powered ankle-foot prostheses may not
optimize the function of Veterans with TTAs during walking. Targeted, real-time visual feedback training of
peak propulsive ground reaction forces increased propulsion and improved walking function in older (>65
years) and post-stroke adults, who typically have impaired ankle power. To our knowledge, no research has
addressed how visual feedback of peak propulsive force affects the use of passive-elastic or powered ankle-
foot prostheses by people with TTAs. In the proposed research, we will determine the underlying metabolic
costs, biomechanics, stability, and muscle activity resulting from targeted real-time visual feedback training of
peak propulsive force to identify how Veterans with a TTA benefit from more effective use of a passive-elastic
prosthesis and/or a battery-powered ankle-foot prosthesis and to determine if the addition of mechanical power
provided by a battery-powered ankle-foot prosthesis can further enhance the function of Veterans with
unilateral TTAs during walking. 30 Veterans with unilateral TTAs will use their own passive-elastic prosthesis
both with and without visual feedback training during level-ground walking, while we measure their metabolic
costs and biomechanics. Then, they will use a powered ankle-foot prosthesis (emPOWER, BiONX, Ottobock)
both with and without visual feedback training during level-ground walking, while we measure their metabolic
costs and biomechanics. With each prosthesis, subjects...

## Key facts

- **NIH application ID:** 11006243
- **Project number:** 5I01RX002943-05
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Alena Grabowski
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11006243

## Citation

> US National Institutes of Health, RePORTER application 11006243, Can Sensory Feedback Training Improve the Biomechanical and Metabolic Effects of Using Passive or Powered Lower Limb Prostheses During Walking for Veterans with Transtibial Amputations? (5I01RX002943-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11006243. Licensed CC0.

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