A Quantitative Analysis of Transfemoral Prosthetic Alignment

经股假肢对准的定量分析

• 批准号: 7870709
• 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/7870709
• 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. PUBLIC HEALTH RELEVANCE: Project Narrative This work is directly applicable to the VA's Patient Care Mission because the results may improve the gait and quality of life of persons with lower-extremity amputations. The gait of persons with transfemoral amputations is inferior to that of able-bodied individuals due to deficiencies in socket fit, prosthetic alignment, and performance of components. This proposed work will characterize the relationship between prosthetic misalignment and adaptations in transfemoral amputee gait, including gait asymmetries, kinetic inefficiencies, increased energy expenditure, and residual limb pain. With a better understanding of how prosthetic alignment affects the walking performance of transfemoral amputees, this study will establish criteria to better quantify outcomes related to alignment. Furthermore, a thorough understanding of how transfemoral amputees control their prosthetic knee may have implications for rehabilitation therapies and provide insight for improved prosthetic knee designs.

描述（由申请人提供）： 项目概要/摘要 假肢对准是下肢截肢者成功康复的一个重要方面，是假肢能否恢复功能、最大限度地减少步态偏差以及使用者是否舒适的决定因素。假肢师经过培训，根据临床经验和患者反馈，在对齐假肢时遵循迭代程序。假肢师不断修改假肢对准，直到他们对患者的步态偏差很少且感到满意为止。然而，这个过程的可重复性差且缺乏科学依据。为了改进经股骨对准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肢对准变化与截肢者生物力学反应之间的关系。肢体的矢状不稳定是股骨截肢者最关心的问题，因为他们无法直接控制假肢膝关节。因此，股骨截肢者依靠臀部的肌肉策略来控制膝盖的屈曲和伸展。假肢错位的一个实际后果是，它可能需要截肢者产生过多的髋力矩来控制膝关节，从而导致步行过程中代谢能量消耗增加和疲劳。不正确的对准还可能导致步态不对称、假肢部件性能不佳以及接受腔和残肢之间的不良压力，从而引起不适和压疮。本研究的目的是评估单侧经股截肢者的步态生物力学如何因矢状面对齐的系统变化而改变。在直线、水平行走过程中，将研究假肢膝关节的线性平移和假肢足的旋转。为了测量经股截肢者对矢状面对齐变化的反应，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肌电图数据、插座内接触压力和能量消耗测量值。这项拟议的工作将描述假肢错位与经股截肢者步态功能反应之间的关系，包括生物力学不对称、能量消耗增加和残肢疼痛。这项研究的结果将提供对经股截肢者如何控制假肢膝关节的全面了解，并可能为临床假肢对准过程建立更系统的方法。 公共卫生相关性： 项目叙述 这项工作直接适用于 VA 的患者护理任务，因为其结果可能会改善下肢截肢患者的步态和生活质量。由于接受腔配合、假肢对准和部件性能方面的缺陷，股骨截肢者的步态不如身体健全的人。这项拟议的工作将描述假肢错位与经股截肢者步态适应之间的关系，包括步态不对称、运动效率低下、能量消耗增加和残肢疼痛。通过更好地了解假肢对齐如何影响经股截肢者的行走表现，本研究将建立标准来更好地量化与对齐相关的结果。此外，全面了解经股截肢者如何控制假肢膝关节可能会对康复治疗产生影响，并为改进假肢膝关节设计提供见解。