Optimizing Prosthetic and Bicycle Fit for Veterans with Transtibial Amputations

优化小腿截肢退伍军人的假肢和自行车适配

• 批准号: 10392840
• 负责人: Alena Grabowski
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392840
• 关键词: Adherence; Affect; Amputation; Ankle; Appointment; Bicycling; Biological; Biomechanics; Body Weight decreased; Cardiovascular Physiology; Conflict (Psychology); Cost efficiency; Custom; Department of Defense; Diabetes Mellitus; Dimensions; Employment; Ensure; Exercise; Femur; Goals; Guidelines; Health Status; Height; Injury; Journals; Leg; Length; Lower Extremity; Measures; Mechanics; Metabolic; Military Personnel; Motion; Muscle; Non-Insulin-Dependent Diabetes Mellitus; Output; Pattern; Peer Review; Physical Function; Physical activity; Physiological; Positioning Attribute; Prevalence; Principal Component Analysis; Prosthesis; Protocols documentation; Quality of life; Randomized; Rehabilitation therapy; Research; Risk; Running; Science; Series; Shoes; Stroke; Time; United States; United States Department of Veterans Affairs; Vascular Diseases; Veterans; Walking; Work; active duty; active lifestyle; arm; base; cardiovascular fitness; cardiovascular health; comorbidity; cost; evidence base; evidence based guidelines; exercise rehabilitation; foot; functional disability; functional restoration; improved; improved functioning; metabolic rate; muscle strength; musculoskeletal injury; prevent; prosthetic foot; satisfaction; service member; symposium

Over one million people in the United States have a leg amputation and this number continues to grow due to the prevalence of diabetes and recent military conflicts. Because of the functional impairment caused by an amputation, it is extremely important to advance rehabilitation that optimizes the use of prostheses so that Veterans with amputations can regain the greatest possible level of health, function, and physical activity. [Low-impact exercise such as bicycling could facilitate return to work/duty after amputation by improving cardiovascular fitness, muscle strength, endurance, and quality of life for Veterans with transtibial amputations (TTAs). Bicycling as exercise could also prevent the deleterious effects of vascular disease and diabetes by improving cardiovascular function, controlling body weight, decreasing the rate of re-amputation, and improving quality of life for Veterans with TTAs. However, it is likely that discomfort and the increased potential for secondary musculoskeletal injury due to the lack of a proper prosthetic/bike fit discourages Veterans with TTAs from using bicycling for rehabilitation and exercise. Moreover, it is unclear how prosthetic and bicycle components, such as pylon length (PL), pedal attachment position (PAP) beneath the prosthetic forefoot versus the pylon, and crank arm length (CAL) affect the biomechanics, metabolic costs, and comfort/ satisfaction of Veterans with TTAs. Thus, our goal is to challenge the state-of-the-science by developing evidence-based prosthetic and bicycle fit guidelines that optimize the biomechanics, metabolic costs, efficiency (mechanical power/metabolic power) and comfort/satisfaction for Veterans with TTAs.] The Department of Veterans Affairs (VA) and Department of Defense (DoD) Rehabilitation Directive has put forth an initiative that aims to dramatically improve and restore function in wounded Veterans and Service members so that they have the choice to return to active duty or productive civilian employment. Our proposed research will establish optimal prosthetic/bicycle fit guidelines, which would enhance function by improving cardiovascular health, controlling body weight, decreasing re-amputation rates, and enhancing quality of life of Veterans with TTAs, thus helping to fulfill this initiative and having high potential impact. Specifically, we aim to: 1) Study 15 Veterans with unilateral TTAs to determine the effects of systematically varying PL, PAP beneath the prosthetic forefoot versus the pylon, and CAL for the affected leg on bicycling biomechanics, metabolic costs, and comfort/satisfaction. 2) Synthesize and disseminate our findings into practical, evidence-based quantitative prosthetic/bicycle fit guidelines for Veterans with TTAs. We hypothesize that a longer PL and shorter CAL for the affected compared to the unaffected leg along with a PAP beneath the pylon compared to beneath the forefoot will maximize mechanical power symmetry and reduce metabolic cost and muscle activity, and thus maximize efficiency and comfort/satisfaction during bicycling in Veterans with unilateral TTAs. [The utilization of evidence-based prosthetic/bicycle fit guidelines that increase symmetry, improve comfort, reduce the risk of injury, decrease metabolic costs, and improve efficiency will directly benefit Veterans with TTAs by increasing their physical activity and function.] Optimized prosthetic/bicycle fit guidelines will allow Veterans TTAs who were previously unable to comfortably ride a bicycle, as well as those currently riding a bicycle, to ride longer with less effort and discomfort, potentially leading to an improved quality of life. Moreover, the prosthetic/bicycle fit guidelines generated by this research will ensure that clinicians are able to fit Veterans with TTAs to bicycles more effectively, leading to shorter appointment times and fewer revisits due to enhanced function and reduced comorbidities.

在美国，超过100万人有截肢的腿，由于 糖尿病和最近的军事冲突的患病率。由于功能障碍是由 截肢，提前康复以优化假体的使用非常重要，以便 截肢的退伍军人可以恢复最大的健康，功能和体育锻炼水平。 [骑自行车之类的低影响运动可以通过改进截肢后促进工作/职责恢复 具有纵容截肢的退伍军人的心血管健身，肌肉力量，耐力和生活质量 （ttas）。骑自行车作为运动也可以防止血管疾病和糖尿病的有害影响 改善心血管功能，控制体重，降低重复率并提高 TTA的退伍军人的生活质量。但是，不适和增加的潜力可能 由于缺乏适当的假肢/自行车，次要肌肉骨骼损伤使TTA的退伍军人劝阻退伍军人 从使用骑自行车进行康复和运动。而且，目前尚不清楚假肢和自行车如何 组件，例如塔长度（PL），踏板附着位置（PAP），下方的前脚下方 对塔和曲柄臂长（CAL）影响生物力学，代谢成本和舒适性/ 用TTA的退伍军人满意。因此，我们的目标是通过发展来挑战最先进的水平 基于证据的假肢和自行车拟合指南，可优化生物力学，代谢成本，效率 （机械能力/代谢能力）和TTA的退伍军人的舒适/满意。] 退伍军人事务（VA）和国防部（DOD）康复指令提出了一项倡议， 旨在显着改善和恢复受伤的退伍军人和服务成员的功能，以便他们 可以选择重返现役或有生产力的平民就业。我们提出的研究将建立 最佳的假肢/自行车拟合指南，这将通过改善心血管健康来增强功能， 控制体重，降低重复率以及通过TTA的退伍军人的生活质量提高， 因此有助于实现这一倡议并具有很大的潜在影响。具体来说，我们的目的是：1）研究15 具有单方面TTA的退伍军人，以确定系统变化的PL，PAP的影响 假肢前脚与塔架，以及受影响的腿部骑自行车生物力学，代谢成本， 和舒适/满意。 2）将我们的发现合成并将我们的发现传播到实用的，循证的定量 带有TTA的退伍军人的假肢/自行车拟合指南。我们假设一个更长的PL和更短的Cal 与未受影响的腿以及塔下方的PAP相比，受影响的受影响 前脚将最大化机械功率对称性并降低代谢成本和肌肉活动，从而 在具有单方面TTA的退伍军人的骑自行车期间，最大化效率和舒适性/满意度。 [利用率 基于证据的假肢/自行车拟合指南，以增加对称性，提高舒适性，降低 伤害，降低代谢成本以及提高效率将通过增加TTA的退伍军人直接使退伍军人受益 他们的体育锻炼和功能。]优化的假肢/自行车拟合指南将允许退伍军人TTA 以前无法舒适地骑自行车以及当前骑自行车的人骑自行车 努力减少和不适，可能会改善生活质量。而且， 这项研究生成的假肢/自行车拟合指南将确保临床医生能够适合退伍军人 将ttas更有效地骑自行车，导致约会时间较短，而由于 功能增强和合并症。