A Quantitative Analysis of Transfemoral Prosthetic Alignment

经股假肢对准的定量分析

• 批准号: 8466754
• 负责人: Steven A. Gard
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8466754
• 关键词: Affect; Amputation; Amputees; Area; Biomechanics; Clinical; Data; Decubitus ulcer; Educational process of instructing; Energy Metabolism; Equation; Exhibits; Fatigue; Feedback; Flexor; Gait; Health Personnel; Hip Joint; Hip region structure; Hour; Individual; Inferior; Judgment; Kinetics; Knee; Knee joint; Limb structure; Lower Extremity; Measurement; Measures; Metabolic; Methods; Mission; Muscle; Muscle Fatigue; Outcome; Pain; Patient Care; Patients; Performance; Persons; Procedures; Process; Prosthesis; Quality of life; Rehabilitation Outcome; Rehabilitation therapy; Relative (related person); Reporting; Research; Research Personnel; Residual state; Rotation; Techniques; Time; Training; Translations; Variant; Visual; Walking; Work; abstracting; base; cost; design; experience; foot; functional restoration; gait examination; improved; insight; kinematics; pressure; prosthetic alignment; response; theories

DESCRIPTION (provided by applicant): Project Summary/Abstract Prosthetic alignment is an important aspect in the successful rehabilitation of lower-limb amputees and is a deciding factor in whether the prosthetic limb will restore function, minimize gait deviations, and be comfortable for the user. Prosthetists are trained to follow an iterative procedure when aligning a prosthetic limb that relies on clinical experience and patient feedback. The prosthetist continually modifies prosthetic alignment until they are satisfied that the patient exhibits few gait deviations and is comfortable. However, this process suffers from poor repeatability and little scientific justification. In order to improve the process of transfemoral alignment and promote an objective basis for practice, researchers and clinicians must first acquire a better understanding of the relationship between variations in prosthetic alignment and the biomechanical response of the amputee. Sagittal instability of the limb is a primary concern for transfemoral amputees because they do not have direct control of their prosthetic knee joint. As a result, transfemoral amputees rely on muscle strategies at the hip to control knee flexion and extension. A practical consequence of prosthetic misalignment is that it may require the amputee to generate excessive hip moments to control their knee joint, resulting in increased metabolic energy expenditure and fatigue during walking. Improper alignment may also contribute to gait asymmetries, poor performance of prosthetic components, and undesirable pressure between the socket and residual limb, giving rise to discomfort and pressure sores. The purpose of this study is to evaluate how gait biomechanics of persons with unilateral, transfemoral amputations are altered in response to systematic changes in sagittal- plane alignment. Both linear translations of the prosthetic knee and rotations of the prosthetic foot will be investigated during straight, level walking. To measure the response of transfemoral amputees to variations in sagittal-plane alignment, we will collect kinematic and kinetic data using quantitative gait analysis. We will also acquire EMG data of hip musculature, intrasocket contact pressure, and energy expenditure measurements. This proposed work will characterize the relationship between prosthetic misalignment and the functional response of transfemoral amputee gait, including biomechanical asymmetries, increased energy expenditure, and residual limb pain. The results of this study will provide a thorough understanding of how transfemoral amputees control their prosthetic knee joint and may establish a more systematic approach to the process of clinical prosthetic alignment.

描述（由申请人提供）： 项目摘要/抽象假体对齐是成功康复的重要方面，是下limb amputees的成功康复，是假肢肢体是否会恢复功能，最小化步态偏差并使用户满意的决定因素。当对齐依靠临床经验和患者反馈的假肢时，假肢者接受训练以遵循迭代程序。假肢不断修改假体的一致性，直到他们满意患者表现出很少的步态偏差并且很舒适。但是，这个过程遭受了重复性差，科学上的理由很少。为了改善经济对准的过程并促进实践的客观基础，研究人员和临床医生必须首先更好地了解假体一致性变化与截肢者的生物力学反应之间的关系。肢体的矢状不稳定性是转释隔板的主要关注点，因为它们无法直接控制其假肢关节。结果，经济截肢者依靠臀部的肌肉策略来控制膝盖屈曲和伸展。假肢未对准的实际结果是，它可能要求截肢者产生过多的髋关节矩以控制其膝关节，从而增加了代谢能量消耗和步行过程中的疲劳。不当比对也可能导致步态不对称，假体成分的性能差以及插座和残留肢体之间的不良压力，从而导致不适和压力疮。这项研究的目的是评估如何随着矢状平面比对的系统变化的响应而改变具有单方面，额外截肢者的步态生物力学。假肢的线性翻译和假体脚的旋转都将在直达级别的步行期间进行研究。为了衡量转际截肢者对矢状平面比对变化的响应，我们将使用定量步态分析收集运动学和动力学数据。我们还将获取髋部肌肉组织的EMG数据，耗时接触压力和能量消耗测量值。这项提出的工作将表征假肢未对准与经截肢步态的功能反应之间的关系，包括生物力学不对称，能量消耗增加和残留的肢体疼痛。这项研究的结果将彻底了解转际截肢者如何控制其假体膝关节，并可能在临床假体一致性过程中建立更系统的方法。