Prosthetic foot stiffness, which is typically invariable for commercially available prosthetic feet, needs to be considered when prescribing a prosthetic foot. While a biological foot adapts its function according to the movement task, an individual with lower limb amputation may be limited during more functionally demanding gait tasks by their conventional energy storing and return prosthetic foot.
How do changes in prosthetic foot stiffness during incline walking affect biomechanical measures as well as perception of participants.
Kinetic and kinematic data were collected during incline walking, for five participants with trans-tibial amputation. A mixed model analysis of variance was used to analyse the effects of changing the stiffness during incline walking, using a novel variable-stiffness unit built on a commercially available prosthetic foot. Biomechanical results were also analysed on an individual level alongside the participant feedback, for a better understanding of the various strategies and perceptions exhibited during incline walking.
Statistically significant effects were only observed on the biomechanical parameters directly related to prosthetic ankle kinematics and kinetics (i.e., peak prosthetic ankle dorsiflexion, peak prosthetic ankle power, dynamic joint stiffness during controlled dorsiflexion). Participant perception during walking was affected by changes in stiffness. Individual analyses revealed varied perceptions and varied biomechanical responses among participants.
While changes in prosthesis mechanical properties influenced the amputee\'s experience, minimal immediate effects were found with the overall gait pattern. The reported inter-participant variability may be due to the person\'s physical characteristics or habitual gait pattern, which may influence prosthesis function. The ability to vary prosthetic foot stiffness during the assessment phase of setting up a prosthesis could provide useful information to guide selection of the appropriate prosthetic device for acceptable performance across a range of activities.

Previous research has shown that there are differences in mechanical energy, kinematics, and muscle activation when comparing walking on level and incline surfaces, especially on inclines above 15%. Muscle activations are significantly different while walking on extreme inclines, suggesting a different coordination pattern. We utilized continuous relative phase to assess walking kinematic coordination with respect to increased incline angles. Twelve healthy, college-aged individuals walked for 7 inclines of 1 minute each on a motorized treadmill at 3 mph at 0%, 5%, 10%, 15%, 20%, 25%, and 30% inclines. Kinematic data were collected during the last 20 seconds of each stage (120 Hz). Segmental and joint angles and angular velocities in the sagittal plane were calculated, from which continuous relative phase was determined for 3 joint couples: hip-knee, hip-ankle, and knee-ankle. There were significant differences in the coordination patterns during the first part of the contact phase in the hip-knee and hip-ankle couplings between the 0% and 30% inclines, with all 3 joint couplings becoming more in-phase at inclines above 15%. Importantly, the hip-knee coupling changed significantly from more out-of-phase to more in-phase between 10% and 15% incline. Shifting lower-extremity joint coordination in response to extreme inclines identifies potential coordinative strategies to achieve steep walking.

Larger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM.
Would the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces?
Ten Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups.
Participants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher.
Study results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.

Ankle exoskeletons can improve walking mechanics and energetics, but few untethered devices have demonstrated improved performance and usability across a wide range of users and terrains. Our goal was to design and validate a lightweight untethered ankle exoskeleton that was effective across moderate-to-high intensity ambulation in children through adults with and without walking impairment.
Following benchtop validation of custom hardware, we assessed the group-level improvements in walking economy while wearing the device in a diverse unimpaired cohort (n = 6, body mass = 42-92 kg). We also conducted a maximal exertion experiment on a stair stepping machine in a small cohort of individuals with cerebral palsy (CP, n = 5, age = 11-33 years, GMFCS I-III, body mass = 40-71 kg). Device usability metrics (device don and setup times and System Usability Score) were assessed in both cohorts.
There was a 9.9 ± 2.6% (p = 0.012, range = 0-18%) reduction in metabolic power during exoskeleton-assisted inclined walking compared to no device in the unimpaired cohort. The cohort with CP was able to ascend 38.4 ± 23.6% (p = 0.013, range = 3-132%) more floors compared to no device without increasing metabolic power (p = 0.49) or perceived exertion (p = 0.50). Users with CP had mean device don and setup times of 3.5 ± 0.7 min and 28 ± 6 s, respectively. Unimpaired users had a mean don time of 1.5 ± 0.2 min and setup time of 14 ± 1 s. The average exoskeleton score on the System Usability Scale was 81.8 ± 8.4 (\"excellent\").
Our battery-powered ankle exoskeleton was easy to use for our participants, with initial evidence supporting effectiveness across different terrains for unimpaired adults, and children and adults with CP. Trial registration Prospectively registered at ClinicalTrials.gov (NCT04119063) on October 8, 2019.

Research has shown that preferred walking speed results in a minimization of the cost of transport on flat surfaces. However, it has also been shown that over non-smooth surfaces other variables, such as stability, are necessary for task completion increasing the cost of transport. The purpose of this research was to investigate the effect of incline walking on the cost of transport, assessing the effect of raising the center of mass as a potential variable affecting preferred walking speed, such that the cost of transport is no longer minimized. 12 healthy, college-aged male participants completed walking trials on a treadmill at inclines of 0%, 5%, 10%, 15%, and 20% at three different continuous speeds (1mph, 2mph and 3mph) and a preferred walking speed for 4-5 min. Cost of transport was calculated using the oxygen consumption collected during the last minute of each stage. Up to 20% incline, the cost of transport was lowest on each incline for the preferred walking speed trials. On inclines greater than 20%, many participants were unable to complete the task with respiratory exchange ratios less than 1.0. We conclude that inclines up to 20% do not induce an alternative challenge affecting the established relationship that humans prefer to walk at speeds that minimize the cost of transport despite the increased need to raise the center of mass.

Instrumented treadmills are potentially useful tools for the assessment of gait parameters in orthopaedic clinical settings, but their measurement properties remain uncertain.
What is the discriminant validity and reproducibility of spatiotemporal and kinetic gait parameters measured by a pressure-instrumented treadmill at different speeds and inclinations in patients with knee osteoarthritis (KOA)?
A total of 54 patients with unilateral KOA and 23 healthy controls took part in the study. Step length, single-limb support duration and ground reaction force were recorded during level and uphill walking at 3 and 4 km/h using a commercially-available treadmill instrumented with an integrated pressure platform. We examined discriminant validity (difference between involved and uninvolved side as well as against healthy controls) and test-retest reproducibility (reliability and agreement).
Significant side differences were observed for single-limb support duration and ground reaction force at touchdown in all conditions (P < 0.05). All the investigated gait parameters showed acceptable reliability and agreement, except step length at 4 km/h uphill.
We conclude that the pressure-instrumented treadmill used in this study may have good clinical utility for quantitative gait analysis in patients with KOA under different experimental conditions.

Walking is a popular form of exercise and is associated with many health benefits; however, frontal-plane knee joint loading brought about by a large internal knee-abduction moment and cyclic loading could lead to cartilage degeneration over time. Therefore, knee joint mechanics during an alternative walking exercise needs to be analyzed. The purpose of this study was to examine the lower-extremity joint mechanics in the frontal and sagittal planes during incline walking. Fifteen healthy males walked on a treadmill at five gradients (0%, 5%, 10%, 15%, and 20%) at 1.34m/s, and lower-extremity joint mechanics in the frontal and sagittal planes were quantified. The peak internal knee-abduction moment significantly decreased from the level walking condition at all gradients except 5%. Also, a negative relationship between the internal knee-abduction moment and the treadmill gradient was found to exist in 10% increments (0-10%, 5-15%, and 10-20%). The decrease in the internal knee-abduction moment during incline walking could have positive effects on knee joint health such as potentially reducing cartilage degeneration of the knee joint, reducing pain, and decreasing the rate of development of medial tibiofemoral osteoarthritis. This would be beneficial for a knee surgery patient, obese persons, and older adults who are using incline walking for rehabilitation and exercise protocols. Findings from the current study can provide guidance for the development of rehabilitation and exercise prescriptions incorporating incline walking.