A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees

Abstract

The microprocessor-controlled prosthesis was not found to be less cognitively demanding than a conventional prosthesis.

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

“…The difficulty of the secondary tasks likewise varied across studies. No significant differences between the MPK and NMPK conditions were measured for users of swingonly MPKs walking on a treadmill [95], swing and stance MPK users walking in a laboratory [94], or swing and stance MPK users walking outside the laboratory over paved ground [73]. Hafner and Smith reported that subjects demonstrated a significant increase in outdoor SSWS without a significant change in divided attention task performance when using a swing and stance MPK compared with an NMPK [72].…”

“…Physiological measures of cognitive demand reported in the MPK literature include distance traveled during a divided attention task, SSWS during a divided attention task, sway velocity during a divided attention task, serial subtraction test, Controlled Oral Word Association Test, and the Category Test. Perceived measures of cognitive demand that have been reported include the PEQ-A and the Prosthetic Cognitive Burden Scale (PCBS) [72][73]80,[94][95].…”

“…Objective tests of divided attention have rarely reported significant differences in physiological measures of the cognitive demand required for ambulation when comparing MPKs and NMPKs [72][73][94][95]. No consistent measure of cognitive demand was used across the reviewed studies, but all included a measure of performance (e.g., head sway, accuracy of responses, number of correct responses) as subjects walked while performing a secondary (i.e., unrelated) task.…”

“…Of those studies that included primary and secondary tasks, Heller et al [95] and Williams et al [94] selected an experimental design similar to that noted previously by goal 1. Both controlled the performance task (walking speed) while assessing the outcomes of a variety of secondary tasks (e.g., response accuracy and/or body sway).…”

Effects of cognitive load and prosthetic liner on volitional response times to vibrotactile feedback

“…In contrast to nondisabled adults, who typically manage such conditions with ease, ambulating with a transfemoral prosthesis requires significant cognitive effort because of the loss of proprioception and motor control at the ankle and knee joints, which diminishes the normal motor and balance mechanisms relative to nondisabled individuals [13,[15][16]. The literature also describes how people with amputation must rely on visual cues in order to monitor the prosthetic device, which interferes with their ability to perform other tasks and is considered an additional cognitive burden [13,[17][18][19]. For example, persons with LLA are often required to physically look at their prosthesis when descending stairs to prevent themselves from tripping.…”