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JoVE Journal Medicine

Medicine

An Experimental Approach to Induce Trips in Lower-Limb Amputees

Published: September 22, 2023 doi: 10.3791/64570
1, 2, 3, 3, 3
1Department of Physical Education, Federal University of Paraná, 2Department of Biomedical and Electronics Engineering, University of Bradford, 3Department of Occupational Therapy, Federal University of Paraná

Abstract

Reestablishing balance after a trip is challenging for lower-limb amputees and often results in a fall. The effectiveness of reestablishing balance following a trip depends on factors such as amputation level (transtibial or transfemoral) or which limb is tripped (prosthetic or sound/lead or trailing). Understanding the recovery responses can help identify strategies to avoid a trip becoming a fall and what trip-response functionality could be designed into a prosthesis. This study presents an experimental approach for inducing unexpected trips in individuals with amputation. Tripping was manually triggered by activating an electromagnetic device to raisea polypropylene wire to obstruct (bring to a near halt) theswinging limb during its mid-swing phase. A safety harness attached to a ceiling rail ensured participants did not hit the ground if they failed to reestablish balance following the trip (i.e., it prevented a fall from occurring). One transtibial amputee completed repeated walking trials in which a trip was induced around 1 out of 15 times to avoid it being anticipated. 3D kinematics were determined via two smartphones (60Hz) using the OpenCap software, highlighting that the experimental approach induced meaningful tripping/recovery responses dependent on which limb was tripped (prosthetic or sound). The presented methodology avoids using a rigid obstacle, potentially reducing the risk of injuries, and is inexpensive and easy to set up. Importantly it permits a trip to be unexpectedly introduced during the mid-swing phase of the gait and hence provides an approach for identifying real-world trip recovery responses. When tripping the sound limb, participants could 'disentangle' from the trip-wire (post-trip) by plantarflexing the ankle, but such action was not possible when tripping the prosthetic limb.

Introduction

It has been estimated that 57.7 million people worldwide live with limb amputation, of which ~ 65% occur in the lower limbs1. Lower limb amputation may derive from several factors (e.g., acute traumatic events, disease progression, health complications, life-saving surgery, and congenital deformity). It has been associated with high mortality and morbidity rates for those with poor health conditions2. In addition, mobility reestablishment after amputation is crucial to regaining independent living and life quality and is one of the most significant challenges for prosthesis users3.

After an amputation, mobility limitations are accompanied by a reduced range of motion4, decreased strength5, diminished confidence in balance6, and can lead to a marked joint degeneration in the non-amputated limb7. These changes are described as relevant fall risk factors8. Indeed, lower limb prosthesis users are twice as likely to fall compared to the general population9. Around 40% and 80% of persons with transtibial and transfemoral amputations fallat least once a year9,10. Falls occur most often during walking11,12, and amputees with a limited walking ability (adjusted for exposure) are six times more likely to fall and eight times more likely to suffer an injury11. In addition, a lower limb prosthesis user that has experienced a fall in the past year has a 13% likelihood of falling again. The probability rises to 28% if they experienced two falls in the past six months13. Thus, falling is a concerning problem for lower-limb amputees.

Tripping while walking is a predominant factor for falls in prosthetic users. During a trip, there is a sudden interruption of the swinging limb (e.g., caused by an obstacle or uneven terrain), making the body rotate forward rapidly on the support limb and causing a large forward thrust14,15. Maintaining/recovering balance after tripping for prosthetic users can be much more difficult due to the absence of ankle or knee joints, associated musculature, and reduced sensory feedback. An ineffective response to a stumble may culminate in it becoming a fall, which may have significant physical, psychological, and social consequences16.

Several studies have focused on describing tripping recovery strategies for able-bodied and older adults17,18,19,20 by inducing a trip in a laboratory-controlled scenario. Several methods have been applied to produce a disturbance to generate a trip. There are many ways to impose a trip disturbance, including obstructing the lower-limb segment during its swing phase using a rope attached to the ankle21 or using obstacles unexpectedly placed in front of someone walking on a treadmill20,22. In addition, some studies have applied sudden changes in the treadmill's speed to disturb dynamic balance (i.e., induce a stumble)23. Finally, others have used rigid objects that are manually18,24,25 or automatically22,26 positioned in the way of the swinging limb to cause a trip event during overground walking.

Despite successfully applying such strategies in older adults, only a few studies have induced a trip in lower limb amputees, with fewer still involving those with transfemoral level amputation21,25,26. For instance, Crenshaw and colleagues tripped TFA while walking over-ground using a hidden rigid obstacle manually activated to appear from the ground. However, such a way of introducing an obstacle is technically demanding and hence can be expensive to reproduce. Shirota and colleagues induced a trip in TFA while participants walked on a treadmillusing a rope attached to the ankle. Even though a trip was caused, using a rope may have limited the experiment as it likely impeded the participants from walking naturally21. More recently, Eveld and colleagues tripped TFA by placing steel blocks on a treadmill conveyer belt using an integrated targeting algorithm to allow the objects to cause the disturbance at different stages of the swing phase (early, mid, late swing)26. However, treadmill-based protocols may not fully reproduce the conditions during over-ground walking27. Using a treadmill-based protocol is also not ideal when investigating TTA or TFA who use microprocessor-controlled foot-ankle or knee devices because the automatic sensors used in such devices are set up for walking on a solid/stationary surface. Hence, when walking on a non-stationary surface, these sensors may trigger the device's hydraulic cylinders to 'self-adjust' their resistances to an incorrect level.

In previous studies that induced a trip during overground walking, the trip disturbance was caused by the lead limb contacting a solid obstacle that appeared in front of them. However, using such rigid objects may cause foot injuries due to impact forces25. Here we describe an experimental approach for tripping the swinging limb that avoids the issue of the foot hitting something solid. The tripping mechanism is formed by an electromagnetic system that controls the release of a movable spring-operated plate. When the electromagnetic device is deactivated, the spring-operated plate positioned on one side of the walkway is pulled upwards, raising a polypropylene wire (4 mm diameter)positioned perpendicularly to the walking direction. The wire is anchored to the opposite side of the walkway and is raised to a height of 0.1 m. Dummy wires (3 to 4, spaced at least 1 m apart) are positioned across the walkway so that participants cannot guess which wire would cause the disturbance. The experimenter manually deactivates the electromagnetic device with the contralateral limb positioned on the ground, slightly ahead of the wire, just after the instance of toe-off of the swinging limb. Therefore, when the wire is raised, the swinging segment is consistently caught during the mid-swing phase28. The mid-swing phase was selected because the horizontal velocity of the swinging foot at this phase is close to its maximal (~3 times CoM forward speed) and is at its minimum clearance above the ground, and hence is the period when most trips occur in real-world conditions. The height of the wire (i.e., 0.1 m) is sufficient to allow the foot to be consistently caught (on approximately shoe-laces area). The study aimed to establish if the proposed protocol could create a trip disturbance and induce meaningful/real-life recovery responses. Only a TTA was analyzed in the present protocol, as higher-level amputations represent the more complex cases and present higher fall rates.

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Protocol

The University's ethics committee approved procedures, and the participant signed an informed consent form before participating.

1. Participant

NOTE: One Transtibial (TTA) amputee attending a local amputee rehabilitation center was invited and agreed to participate in the study. The participant was able to walk independently. Exclusion criteria were clinical conditions other than their amputation that could affect balance and mobility (e.g., neurological, orthopedic, or rheumatic disorders); ongoing pain, phantom pain, or pressure sores on the prosthetic limb, and difficulties understanding simple commands (i.e., less than 24 points in the Mini-Mental State Examination29). In addition, the participant had over six years of experience with the current prosthesis.

  1. Prosthetic details
    1. Request the prosthetic details from the TTA. Note the experience of the TTA with the prosthesis. Ensure that the participant has a high ability to walk using the prosthesis.
      ​NOTE: The TTA used a prosthesis, a silicone suction socket (silicon liner with five sealing rings), and a carbon fiber foot (Table of Materials). Experience with the current prosthesis was six years. The amputation was due to trauma, and the participant was classified as level K4 according to the Medicare Functional Classification30. According to the standardized functional classification, the participant had a high ability to walk using the prosthesis and was considered a young active adult31.

2. Experimental procedures

  1. Design a system to induce trips.
    1. Construct a custom-made device in which a spring is electronically released to raise a polypropylene wire (diameter of 4 mm and negligible mass) that catches the trailing limb (sound or prosthetic limb) during the mid-swing phase.
    2. Connect the system to a wooden box that allows a lever (approximately 10 cm) to be rotated upwards around a fixed axis. Connect the polypropylene wire to the end of the lever (away from the axis). Install a spring that pulls on the lever to raise the polypropylene wire about 10 cm from the ground.
      NOTE: Video 1 shows the trigger system and how the wire was positioned to cause the trip (Supplementary Figure 1 and Supplementary Figure 2).
  2. Safety harness system
    NOTE: Inducing a trip while a participant is walking requires safety measures to be adopted.
    1. Ensure the participant wears a full-body harness attached via a polyester rope to an overhead rail.
    2. Adjust the length of the safety rope according to the participant's stature.
      NOTE: The safety rope (diameter of 11 mm) is attached to a specially designed four-wheeled device that sits inside the overhead rail (about 2 m above the participant's head). Adjusting the safety rope to the participant's stature prevents any part of their body (apart from their feet) from touching the floor should they fail to restore balance after the trip disturbance.In addition, the length of the overhead rail (8 m) is sufficient to ensure the participants' walking is unencumbered (see Supplementary Figure 3).
  3. Experimental procedures
    1. According to the following standardized instruction, ask the participant to walk across the laboratory at their usual speed and looking forward as the participant normally would: "You should walk to the end of the walkway using your own pace as if you were walking on a familiar, flat street and look forward as you normally would".
    2. Adjust the participant's starting point to ensure that the contralateral (non-tripped) limb is positioned on the ground slightly ahead of the polypropylene wire, placed approximately 4 m from the starting position. Therefore, the participant could take 4-5 steps at the usual speed before applying the trip disturbance.
      1. The participant is required to complete two blocks of walking. Let the participant perform up to 15 walks in each block with the stumble/trip disturbance applied between the 5th and 15th repetition (randomly determined).
      2. After the trip disturbance, do not let the participant make any further repetitions.
      3. Repeat the same procedures in the second block, which is used to trip the opposite limb to the one tripped in the first block.
        NOTE: The order in which the limbs are obstructed is randomly assigned.
      4. Prior to starting the walking tests, inform the participant that some disturbance could occur, but do not provide any specific information regarding the possibility of tripping. Instead, inform the participant about the possibility of losing balance at some point.
      5. Instruct the participant to recover as best as possible if any disturbance of balance is applied and, if possible, to continue walking to the end of the walkway.
    3. Trigger the system only when the foot of the contralateral (non-tripped) limb is correctly positioned on the ground (i.e., slightly ahead of the wire). Do not activate the system if the participant steps before, on the wire, or if the foot is too far ahead of the wire. These procedures allow the trip disturbance to be applied consistently during the mid-swing phase, reducing the chances of mistrials.
  4. Evaluating whether the system can inducemeaningful recovery responses.
    ​NOTE: The study aimed to develop an experimental approach to cause unexpected trip disturbances in lower-limb amputees. Although the approach causes unexpected trips, the use of dummy wires and the laboratory environment does not allow one to assume that all trips will be totally unexpected. 3D kinematic data from one TTA was collected and analyzed to establish if the protocol could create unexpected trips and hence induce meaningful tripping/recovery responses.
    1. Data acquisition
      1. Position two smartphones 5 m ahead of where the trip occurs are used to record each walking trial. Set the smartphones facing the walking progression line at an angle of approximately 30o.
      2. Synchronize both smartphones, sampling at 60 Hz, using the OneCap software. The OneCap software synchronizes the phones by providing a code that is read by the smartphones. Then, the images are automatically stored on the computer and transferred to be remotely processed. The transfer and successful reconstruction are indicated by the software.
        NOTE: This software automatically recognizes and tracks the limb segments without physical markers and pose detection algorithms transform images to estimate joint centers and provide a relatively accurate kinematic analysis. After being processed, the files can be analyzed using the OpenSim software.
      3. Then, process and transfer the images to the OpenSim software (version 4.4) to perform all kinematic analyses.
        NOTE: A markless system is advantageous, as pilot testing showed that the trip-wire dislodges some physical markers (especially those placed on the foot). A discussion regarding the relative merits of the capture and data processing is beyond the scope of the present protocol. The reader should refer to the work by Uhlrich and colleagues32 for further information.
    2. Data processing and analysis
      NOTE: The OpenSim is a freely available software package that enables one to build, exchange, and analyze computer models of the musculoskeletal system and dynamic simulations of movement. Further details can be obtained on the following site: https://simtk.org/projects/opensim/.

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Representative Results

The safety harness system was assumed to cause no interference in walking and proved effective in preventing falling when trip recovery strategies were unsuccessful. In addition, no injuries (e.g., skin abrasions, bruising) were reported. The noise generated by the release of the spring was not considered an intervening factor since the participants did not prevent tripping from occurring. Furthermore, the time between the instant the system was activated and the impact with the wire was around 60 ms. Thus, it was assumed that the time between the instant the noise produced by the system activation was insufficient to change the course of the swinging limb before tripping. Finally, the location within the walkway where the trip was applied (4 m from the starting point) allowed the participant to achieve a natural walking speed (0.91-0.98 m·s-1) before the disturbance was applied.

The data presented highlight the system's functionality for inducing a trip in TTA, irrespective of which limb is tripped (sound or prosthetic). Two trips were induced and successfully recorded (i.e., one for each limb). No mistrials occurred, as the system was only triggered when the stance foot was correctly positioned slightly ahead of the wire. In addition, the polypropylene wire was sufficiently resistant to obstruct the swing limb without breaking.

Preliminary analysis and results
The angular displacements of the ankle, knee, and hip joint and the vertical displacement of the center of mass when the prosthetic and sound limbs were tripped are presented in Figure 1 and Figure 2, respectively. The gait cycle started at the instant of the foot strike of the contralateral (non-tripped) limb and ended when the trip recovery was completed. The reader should bear in mind that the angular displacement magnitudes and temporal aspects refer to the sound and prosthetic limbs; thus, differences between limbs are expected to be evident. The instant the trip was applied to the prosthetic and sound limbs differed by approximately 60 ms and therefore caused no relevant difference in the protocol. Reactions to tripping made by the ipsilateral/swinging limb can be visualized in Figure 1 in the right panels, while the reactions made by the contralateral/support (sound) limb to such trip events can be visualized in the left panels.

Trip obstruction of the prosthetic limb
The trip was applied when the limb was being transposed forward and occurred just after mid-swing when the thigh segment was just forward or vertical with the knee flexed at approximately 90 degrees. The swinging (prosthetic) limb was reversed into an extension at the hip joint, which led to a slight knee joint extension. It remained in this position during a large part of the recovery period because the participant could not perform a plantarflexion at the prosthesis to release the distal part of the segment from the wire. More obvious reactions were performed by the contralateral/sound limb. Due to the swinging limb being 'halted' in its forward progression, this caused the CoM to rotate over the support limb, resulting in it being rapidly lowered by approximately 0.15 m (see Figure 2).A fast flexion-extension movement of the ankle, knee, and hip joints initiated a short-quick hop and repositioned the support limb 0.15-0.20 m further forwards. This forward repositioning of the support limb arrested the downwards (and forwards) motion of the CoM (see Video 2 and Video 3).

Trip obstruction of the sound limb
When the prosthetic limb was the contralateral/support limb, and the sound segment was obstructed, the sound limb performed most recovery actions. Immediately after the disturbance, rapid ankle plantarflexion and accompanying knee flexion were initiated to 'unhook' the foot from the trip wire. This was followed by rapid forward transposition of the limb to affect a longer-than-normal step length and reposition the limb further forward than it would have been. The more forward positioning of the swinging limb ensured that following foot contact, the limb arrested the downwards (and forwards) motion of the CoM. These actions can be visualized in the videos. Note that the actions executed by the support segment appeared to be "passive", as the body rotated around the ankle with apparently little involvement of the knee and hip joints. Such reactions of the support/prosthetic limb would be expected because the ankle actuators are missing, and the residual segment has a limited possibility to initiate a forward hop to reposition the limb further ahead. Despite the small contribution of the support segment, the participant was successful in reestablishing balance and avoiding a fall (see Video 4 and Video 5).

Figure 1
Figure 1: The angular displacement of the hip (upper panel), knee (middle panel), and ankle (bottom panel) joints for the prosthetic (red lines) and the sound (blue lines) limbs. The left panels represent the reactions of the support (non-tripped) limb, while the right panels represent the reactions of the swinging (tripped) limb. The red or blue dots represent the instant the trip was applied to the prosthetic and sound limbs, respectively. The time is represented by frame number, and the movement duration varies between conditions. Time-frame 1 is heel contact of the contralateral (non-tripped) limb. Please click here to view a larger version of this figure.

Figure 2
Figure 2: The vertical displacement of the center of mass when the sound limb (blue line) or prosthetic limb (red line) was tripped. Please click here to view a larger version of this figure.

Video 1: The view of the tripping system. The video presents the activation of the system used to induce trips. The details of the electronic trigger and the spring system are shown. Please click here to download this Video.

Video 2: Tripping to the prosthetic limb. Participant responses during a trial in which the prosthetic limb was disturbed. Please click here to download this Video.

Video 3: Participant/segmental reconstruction. A trial in which the prosthetic limb was tripped. The red segment represents the prosthetics side. Please click here to download this Video.

Video 4: Tripping to the sound limb. Participant responses during a trial in which the sound limb was disturbed. Please click here to download this Video.

Video 5: Participant/segmental reconstruction. A trial in which the sound limb was tripped. The red segment represents the prosthetics side. Please click here to download this Video.

Supplementary Figure 1: Tripping system-armed. Please click here to download this File.

Supplementary Figure 2: Tripping system-after a trigger. Please click here to download this File.

Supplementary Figure 3: Harness system and lab setup Please click here to download this File.

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Discussion

Although the present protocol brings preliminary results of an experiment designed to describe a trip protocol applied on a transtibial amputee, such an approach can also be safely applied to other amputees, e.g., transfemoral amputees, who are likely to have greater difficulties in recovering balance after a trip. The approach allowed the identification of the most pronounced actions executed to regain balance in response to an unexpectedly induced trip. The protocol can generally be deemed replicating real-world tripping scenarios when the swinging limb makes contact with a ground-based object/obstacle33. However, it was noticed that during the trial, when the prosthetic limb was tripped, the participant was unable to release the distal end of the prosthetic limb from the wire, which is not usual in real-world conditions where most disturbances are immediately removed after impact. Before interpreting the results, the readers should remember that the analyses were performed to show that the proposed protocol is feasible. The investigation was not designed to explore or provide a complete and comprehensive characterization of the responses to a trip. Therefore, further studies are required to compare aspects not addressed in the present protocol, such as amputation level, prosthesis type, etc.

The system consistently induced disturbances to either limb (prosthetic and sound). The kinematic data were comparable to the literature17,18,28. Understanding trip recovery strategies could have a multi-disciplinary impact as such understanding may be used by clinicians as well as prosthetic manufacturers to reduce the risk of falling20.

Most studies designed to identify trip strategies commonly use conventional motion capture systems involving expensive optoelectronic cameras34. Although these systems are accurate for gait analysis, they present restrictions while assessing balance recovery strategies during a trip. For example, they require and rely on correctly identifying reflective markers. In a pilot study, we found that the trip-wire catches the marker placed on the foot of the tripped limb, making the 3D reconstruction of the limb motion challenging. The protocol applied in the present study brings a plausible alternative as it did not rely on physical markers. Moreover, systems operating with physical markers require extensive time for the subject's preparation and data collection and processing35. Although the focus of the present protocol is not the acquisition system, using a markerless 3D gait system is attractive as it allows innovative approaches to be tested.

Several studies that assessed the strategies to recover balance after an induced trip, have used a treadmill and applied a constant speed for all participants19,20,23. Treadmills can provide a more controlled scenario and can be used in settings with reduced spaces. In addition, it has been advocated that treadmills may facilitate repeatedly applying a trip so as to train trip-recovery strategies36,37. However, using a treadmill may fail to replicate a real-world condition in which walking speed is not constant20. It has been shown that walking on a treadmill provides proprioceptive sensory cues that are different from those for walking on the ground38. Thus, selecting a fixed treadmill speed does not accurately reflect the walking speed applied on the ground27. In the present protocol, the participant was free to walk at their customary/usual speed. The participant achieved a walking speed near those expected for amputees39. In addition, a polypropylene wire was used to obstruct the swinging foot segment rather than a rigid obstacle17,40. Using rigid objects may expose the participants to a greater risk of injury. For instance, ankle injuries often result from falls where the foot is tripped41. In addition, toe injuries, such as black toenails, are often reported after an impact trauma against rigid obstacles42.

Others have applied a trip disturbance using a rope attached to the feet, which is problematic as the rope must be dragged and may interfere with walking. Besides, using a rope may also cause the foot to be pulled downwards43, which is unusual in real-world conditions. Therefore, using a polypropylene wire was effective in safely and consistently obstructing the swinging limb. The use of such a system may be an effective alternative with minimal interference with walking characteristics. In addition, the protocol allowed perturbing the swinging limb consistently, i.e., during the mid-swing phase. It has been demonstrated that most trips occur during this phase, where the foot's peak horizontal forward velocity occurs44.

The kinematic data presented in this study highlights the system's usability. A more comprehensive study involving a larger number of participants with different prostheses (e.g., with microprocessors), amputation levels (e.g., transfemoral and transtibial), and walking speeds (e.g., fast and slow walking speeds) is needed to characterize the strategies used by a lower-limb amputee to reestablish balance. Prostheses controlled by microprocessors may elicit different trip responses compared to those when using traditional prostheses. For example, microprocessor-controlled prostheses allow faster walking speeds and better step length symmetry than when using non-computerized prostheses45. It may also be interesting to observe differences in trip responses when using prosthetic feet with different effective foot lengths (which generates differences concerning the moment arm) and/or stiffness46, which are known factors that affect gait performance.

The preliminary results align with those presented by Shirota and colleagues, indicating that when the prosthetic is the tripped limb, the ability to perform reactions with the contralateral/support limb appears to be more crucial in determining the trip responses than those made by the obstructed/swinging limb47.

Although this study has some inherent limitations, the results are encouraging as they highlight that the protocol can be safely applied. Even so, there is a need for further studies involving larger samples to ensure the results of the proposed test are representative. In addition, TTAs may likely produce different responses to tripping than TFAs do, as the preserved knee may produce some relevant actions while organizing a timely response. Finally, there is a concern regarding the trip-wire being caught and 'held' by the swinging prosthetic limb, constituting an unusual disturbance. The lack of active muscles to perform a plantarflexion to release the segment hinders the release of the foot from the wire. Although most reactions of the contralateral/support sound limb can be analyzed, future studies must address these limitations observed while tripping the swinging/prosthetic limb.

The data presented in this study demonstrate that the proposed protocol can provide unexpected trips safely and as close as possible to real life, especially while tripping the sound limb. In addition, the tripping mechanism elicited balance recovery responses in a transtibial amputee when the trip disturbance was applied to either side (prosthetic and sound). Although this study focused on amputees, we emphasize that this protocol can be used for other groups, such as older adults or patient groups with increased fall risk.

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Disclosures

All authors have disclosed any conflicts of interest.

Acknowledgments

The present work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - Financing Code 001

Materials

Name Company Catalog Number Comments
Electromagnetic plates Intelbras https://www.intelbras.com/en/set-of-supports-with-electro-magnetic-lock-fe-150-kt-741-prata Two electromagnetic plates (a fixed and a movable)
Full body safety harness Generic N/A Safety rope 11 mm attached on a rail running 2 m above the head of the participants
Impact Goggle Generic N/A One goggles with lower and side end closures
Insulator tape 3M https://www.3m.com/3M/en_US/p/c/tapes/electrical/ptfe/ Used to obstruct vision at the lower and side edges of goggles
Open Pose  OpenPose https://github.com/CMU-Perceptual-Computing-Lab/openpose Open Pose is a open Software to movement analysis https://github.com/CMU-Perceptual-Computing-Lab/openpose
Open Sim OpenSim  https://simtk.org/projects/opensim/ OpenSim is a softwware to analyse several movement parameters https://simtk.org/projects/opensim/
Polypropilene Wire Generic N/A 4 mm diameter 
Triger system Generic N/A The trigger system was home-made device, formed by a spring that pulls a lever that raises the wire approximately 10cm above the ground level
Video camera Apple https://apple.com The video cameras of two smartphones (apple model 8 and 11) were used.

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References

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Tags

Medicine Lower-limb Amputees Reestablishing Balance Fall Prevention Amputation Level Trip-response Functionality Prosthesis Design Unexpected Trips Electromagnetic Device Polypropylene Wire Mid-swing Phase Safety Harness Repeated Walking Trials 3D Kinematics Smartphones OpenCap Software Tripping/recovery Responses
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Rodacki, A. L. F., Buckley, J. G.,… More

Rodacki, A. L. F., Buckley, J. G., Passos de Oliveira, A. C., Marçal da Silva, R., Bertoli Nascimento, V. An Experimental Approach to Induce Trips in Lower-Limb Amputees. J. Vis. Exp. (199), e64570, doi:10.3791/64570 (2023).

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