Design and Evaluation of a Biarticular Prosthesis to Reduce Gait Compensations

减少步态补偿的双关节假体的设计和评估

• 批准号: 9567852
• 负责人: Patrick Mark Aubin
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-11-01 至 2021-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9567852
• 关键词: Address; Amputation; Amputees; Ankle; Biological; Biological Process; Biomechanics; Computer Simulation; Development; Devices; Distal; Energy-Generating Resources; Engineering; Evaluation; Financial compensation; Flexor; Gait; Gastrocnemius Muscle; Goals; Hip region structure; Human; Impairment; Individual; Kinetics; Knee; Knee joint; Knowledge; Leg; Limb Prosthesis; Limb structure; Lower Extremity; Measures; Mechanics; Medical center; Mentors; Metabolic; Modeling; Muscle; Muscle Fatigue; Muscular Atrophy; Musculoskeletal; Orthotic Devices; Patients; Phase; Physiatrist; Physical Medicine; Physiological; Population; Prosthesis; Quality of life; Rehabilitation therapy; Research; Research Project Grants; Research Training; Role; Scientist; Self-Help Devices; Services; Side; Soleus Muscle; System; Training; Training Programs; Veterans; Walking; Work; ankle joint; base; biomechanical engineering; career; clinical application; cost; design; foot; gait examination; iliopsoas muscle; improved; improved mobility; kinematics; limb amputation; men; models and simulation; multidisciplinary; muscle stress; neuromuscular; novel; professor; programs; prosthetic foot; simulation; treadmill; walking speed

Project Summary / Abstract My proposed research and training program aims to improve the mobility and quality of life of veterans with transtibial (TT) amputation through the development of a novel biarticular prosthesis, and to train me in neuromuscular biomechanics, prosthetic engineering, and gait simulations through the guidance and support of a strong multidisciplinary team of mentors, so that I can become a successful independent research scientist. My long-term career goal is to design, develop and evaluate novel prosthetic, orthotic and assistive devices for people with reduced mobility. Consistent with this goal, I am proposing to design, develop and evaluate a novel biarticular prosthesis that addresses some of the limitations of current lower limb prostheses. Approximately one million people in the US are living with lower limb loss. An important cause of mobility impairment in this population is the loss of the ankle plantar flexors since these muscles are the primary contributors to body support, forward propulsion and swing leg initiation during normal walking. The biarticular gastrocnemius (GAS) has a role distinct from that of the soleus; it provides the dominant source of energy to power the leg into swing phase. Without the GAS, compensatory changes of the remaining leg muscles are necessary, including an increase in the concentric iliopsoas force to accelerate the leg into swing phase. Current prosthetic limbs cannot replicate the physiologic function of the ankle plantar flexors. When walking with conventional prosthetic foot-ankle systems, TT amputees show limited push-off power, and they use adaptive gait strategies, such as increased hip flexor work on the prosthetic side during pre-swing, to compensate for the lack of a biarticular GAS. These compensations are thought to contribute to the increased metabolic cost of amputee walking. To reduce the gait compensations typical of TT amputees, I am proposing to develop a novel biarticular prosthesis (BP) with a clutched spring that spans the ankle and knee joint. The BP will have the ability to generate net positive ankle joint work and to provide energy to power the leg into swing. I will use musculoskeletal modeling and simulations of TT amputee gait to optimize the design of the BP, and I will use gait analysis to evaluate the effect of the BP on gait. The BP has the potential to reduce gait compensations and improve functional mobility in veterans with TT amputation. The proposal has three specific aims: Aim 1: Using simulation, determine subject-specific optimal BP parameters. Aim 2: Demonstrate that the TT amputee gait compensations typically seen with conventional passive- elastic prostheses are reduced with the subject-specific optimal BP across a range of walking speeds. Aim 3: Determine if the Optimal BP reduces the metabolic cost of walking. To accelerate my training and facilitate my development into an independent research scientist, I have brought together mentors with diverse expertise. Dr. Czerniecki is a VA physiatrist and professor of rehabilitation medicine specializing in amputee rehabilitation and gait analysis. Dr. Klute is a VA research career scientist with a vibrant research program focused on prosthetic engineering and amputee mobility. Dr. Thelen is a professor of mechanical and biomechanical engineering and an expert in computational simulations of gait. Dr. Steele is an assistant professor of mechanical engineering and an OpenSim fellow with detailed knowledge or musculoskeletal modeling. Conducting the proposed research project and training program under the guidance of these mentors will allow me to become an expert in the neuromuscular biomechanics of gait, prosthetic engineering, and computational simulations of gait and to establish an independent research career.

项目概要/摘要 我提出的研究和培训计划旨在提高退伍军人的流动性和生活质量 通过开发新型双关节假体进行经胫骨（TT）截肢，并训练我 通过指导和支持进行神经肌肉生物力学、假肢工程和步态模拟 强大的多学科导师团队，使我能够成为一名成功的独立研究人员 科学家。我的长期职业目标是设计、开发和评估新型假肢、矫形器和辅助器具 适合行动不便人士的设备。与这个目标相一致，我建议设计、开发和 评估一种新型双关节假肢，该假肢解决了当前下肢假肢的一些局限性。 美国约有一百万人患有下肢丧失症。流动性的一个重要原因 该人群的损伤是踝关节跖屈肌的丧失，因为这些肌肉是主要的 正常行走过程中对身体支撑、向前推进和摆动腿启动的贡献。双关节 腓肠肌 (GAS) 的作用与比目鱼肌不同；它提供了主要的能源 使腿部进入摆动阶段。没有 GAS，其余腿部肌肉的代偿性变化是 必要的，包括增加向心髂腰肌的力量，以加速腿部进入摆动阶段。 目前的假肢无​​法复制踝关节跖屈肌的生理功能。走路时 使用传统的足踝假肢系统，TT 截肢者的推力有限，他们使用 适应性步态策略，例如在预摆动期间增加假肢侧的髋部屈肌工作，以 弥补双关节 GAS 的缺失。这些补偿被认为有助于增加 截肢者行走的代谢成本。 为了减少 TT 截肢者典型的步态补偿，我建议开发一种新型双关节 假肢 (BP)，带有横跨踝关节和膝关节的离合弹簧。 BP将有能力 产生净正踝关节功并提供能量驱动腿部摆动。我会用 TT 截肢者步态的肌肉骨骼建模和模拟来优化 BP 的设计，我将使用 步态分析评估BP对步态的影响。 BP 有可能减少步态补偿 并改善 TT 截肢退伍军人的功能活动能力。该提案有三个具体目标： 目标 1：使用模拟确定特定于受试者的最佳 BP 参数。 目标 2：证明 TT 截肢者步态补偿通常采用传统的被动- 在一定步行速度范围内，弹性假肢会随着受试者特定的最佳血压而降低。 目标 3：确定最佳血压是否会降低步行的代谢成本。 为了加速我的培训并促进我发展成为一名独立研究科学家，我带来了 具有不同专业知识的导师聚集在一起。 Czerniecki 博士是退伍军人管理局的理疗师和康复学教授 专门从事截肢康复和步态分析的医学。 Klut 博士是 VA 研究职业科学家 拥有一个充满活力的研究项目，重点关注假肢工程和截肢者的活动能力。塞伦博士是一位 机械和生物力学工程教授，步态计算模拟专家。博士。 Steele 是机械工程系助理教授和 OpenSim 研究员，拥有详细的知识或 肌肉骨骼建模。在指导下开展拟议的研究项目和培训计划 这些导师将使我成为步态、假肢的神经肌肉生物力学方面的专家 步态的工程和计算模拟并建立了独立的研究生涯。