Cognitive performance and brain dynamics during walking with a novel bionic foot: A pilot study

Objectives The objectives are to determine neural dynamics during gait using electro-encephalography and source localization, and to investigate the attentional demand during walking in able-bodied individuals, and individuals with an amputation. Materials & methods Six able-bodied individuals conducted one experimental trial, and 6 unilateral transtibial and 6 unilateral transfemoral amputees performed 2 experimental trials; the first with the prosthesis currently used by the subjects and the second with a novel powered transtibial prosthesis, i.e. the Ankle Mimicking Prosthetic foot 4.0. Each experimental trial comprised 2 walking tasks; 6 and 2 minutes treadmill walking at normal speed interspersed by 5 minutes of rest. During 6 minutes walking the Sustained Attention to Response (go-no go) Task, which measures reaction time and accuracy, was performed. Electro-encephalographic data were gathered when subjects walked 2 minutes. Motor-related cortical potentials and brain source activity during gait were examined. Normality and (non-) parametric tests were conducted (p<0.05). Results and discussion In contrast to transtibial amputees, transfemoral amputees required more attentional demands during walking with Ankle Mimicking Prosthetic foot 4.0 compared to the current passive prosthetic device and able-bodied individuals (reaction time and accuracy: p0.028). Since risk of falling is associated with altered attentional demands, propulsive forces of the novel device need to be better controlled for transfemoral amputees. No motor-related cortical potentials at Cz were observed in transfemoral amputees walking with the novel prosthesis, whereas motor-related cortical potentials between transtibial amputees and able-bodied individuals during walking at normal speed did not differ. The first positive electro-physiological peak deflection appeared during toe-off phase and showed higher activity within the underlying brain sources in transtibial amputees walking with Ankle Mimicking Prosthetic foot 4.0 compared to able-bodied individuals. The required higher neural input to accomplish the same physical activity compared to able-bodied individuals is possibly due to the limited acclimation period to the novel device and consequently increased afferent sensory feedback for postural control.