Restoring Proprioception to Improve Balance and Gait in Lower-Limb Amputees

恢复本体感觉以改善下肢截肢者的平衡和步态

• 批准号: 10153832
• 负责人: Bailey Anne Petersen
• 金额: $ 3万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 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 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10153832
• 关键词: Acceleration; Amputation; Amputees; Ankle; Biomimetics; Clinical; Code; Communities; Complex; Development; Electric Stimulation; Environment; Equilibrium; Esthesia; Feedback; Frequencies; Functional disorder; Funding; Gait; Goals; Impairment; Implant; Individual; Joint Prosthesis; Joints; Knee; Knee joint; Lateral; Light; Limb Prosthesis; Lower Extremity; Measurement; Measures; Mechanics; Methods; Modality; Motion; Movement; Nervous system structure; Neurostimulation procedures of spinal cord tissue; Participant; Pathology; Pattern; Perception; Physiologic pulse; Population; Posture; Proprioception; Prosthesis; Proxy; Psychophysics; Reporting; Reproduction; Safety; Sensory; Stimulus; Surface; Tactile; Techniques; Testing; Time; Training; United States National Institutes of Health; Upper Extremity; Walking; Width; ankle joint; efficacy evaluation; epidural space; experimental study; fall risk; falls; improved; improved mobility; indexing; interest; joint mobilization; kinematics; limb amputation; limb movement; motor control; neural patterning; neuroprosthesis; neuroregulation; response; sensor; sensory feedback; sensory substitution; spinal nerve posterior root

Abstract Lower-limb amputees can suffer from a wide range of gait impairments, ranging from compensatory movements to a substantially higher fall risk than the average population. This increased fall risk can be partially attributed to reduced or complete lack of tactile and proprioceptive feedback from the prosthetic limb. There has been significant recent interest in providing sensory feedback via sensorized neuroprostheses. However, these studies have primarily focused on restoring tactile feedback in upper-limb amputees. The aim of this study is to provide natural proprioceptive feedback in lower-limb amputees through lumbosacral spinal cord stimulation (SCS). Experiments will be conducted as an addition to an ongoing NIH-funded project using FDA-cleared SCS leads implanted percutaneously into the lateral lumbar epidural space. To determine the parameters required to evoke naturalistic percepts of joint motion, we will first evaluate the effects of stimulus patterning on the naturalness of evoked proprioceptive sensations. Using an adapted cross-modal congruency effect (CCE) test as a proxy for naturalness, we will quantify which stimulation patterns (constant frequency or biomimetic) create a more natural percept, as indicated by a higher CCE score. To evaluate the effect of stimulation on the subject’s ability to incorporate these percepts as proprioception, we will use a variety of stimulation patterns with varying degrees of naturalness and evaluate the proprioceptive accuracy for either static or dynamic percepts. We will also study the effect of evoked proprioceptive sensations on improving gait and function using a sensorized prosthesis to provide real-time feedback about joint angles. We will use both clinical and scientific measures of proprioception and gait function to evaluate the efficacy of stimulation. We hypothesize that more natural sensations of proprioception will provide greater accuracy in clinical tests of proprioception and greater improvements in more complex motor control tasks, such as gait, thereby improving the mobility and safety of lower-limb amputees.

抽象的 下肢截肢者可能会遭受多种步态障碍，从 补偿性运动导致跌倒风险显着高于平均人群。 跌倒风险增加的部分原因可能是由于触觉和触觉的减少或完全缺乏 来自假肢的本体感觉反馈最近引起了人们的极大兴趣。 通过传感神经假体提供感觉反馈然而，这些研究已经证实。 这项研究的目的主要是恢复上肢截肢者的触觉反馈。 通过腰骶椎为下肢截肢者提供自然的本体感觉反馈 脊髓刺激（SCS）实验将作为 NIH 资助的正在进行的一项补充进行。 该项目使用经 FDA 批准的 SCS 导线经皮植入侧腰椎硬膜外 为了确定唤起关节运动自然感知所需的参数，我们 首先将评估刺激模式对诱发本体感受自然性的影响 使用适应的跨模态一致性效应（CCE）测试作为代理。 自然性，我们将量化哪些刺激模式（恒定频率或仿生） 创建更自然的感知，如较高的 CCE 分数所示，以评估效果。 为了刺激受试者将这些知觉纳入本体感觉的能力，我们将使用 各种不同自然程度的刺激模式并评估 我们还将研究静态或动态感知的本体感觉准确性。 使用传感假肢诱发本体感觉，改善步态和功能 我们将使用临床和科学来提供有关关节角度的实时反馈。 测量本体感觉和步态功能来评估刺激的效果。 追求更自然的本体感觉感觉将提供更高的准确性 本体感觉的临床测试和更复杂的运动控制任务的更大改进， 例如步态，从而提高下肢截肢者的活动能力和安全性。