Fall risk and prosthetic influence on gait biomechanics in upper limb amputees

跌倒风险和假肢对上肢截肢者步态生物力学的影响

• 批准号: 9000586
• 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: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9000586
• 关键词: Affect; Amputees; Attention; Bilateral; Biomechanics; Characteristics; Chest; Clinical; Data; Development; Devices; Elbow; Elderly; Ensure; Equilibrium; Etiology; Evaluation; Exhibits; Gait; Goals; Hand; Health Hazards; Incidence; Individual; Injury; Internet; Investigation; Lateral; Lead; Light; Limb Prosthesis; Limb structure; Literature; Measures; Metabolic; Motion; Movement; Patient Self-Report; Patients; Pelvis; Performance; Persons; Play; Population; Prevalence; Property; Prosthesis; Prosthesis Design; Psychometrics; Quality of life; Questionnaires; Recording of previous events; Recovery; Regression Analysis; Research; Role; Safety; Statistical Methods; Technology; Telephone Interviews; Training; Upper Extremity; Upper Extremity Fracture; Veterans; Walking; Wit; Wrist; arm; cost; fall risk; falls; grasp; improved; insight; predictive modeling; prosthesis wearer; public health relevance; rehabilitation strategy; simulation; sound; wrist fracture

DESCRIPTION (provided by applicant): Natural arm dynamics play a critical role during ambulation, specifically for ensuring efficient and stable walking and avoiding a fall when faced with sudden perturbation. Accordingly, restriction of arm swing during able-bodied gait has been observed to increase metabolic cost, impair lateral stability, and interrupt natural walking dynamics. Importantly, arresting a fall wit outstretched arms is a common strategy for avoiding bodily injury, with falls causing 97% of upper limb fractures in older adults and 76% of wrist fractures resulting from direct impact to the hand. Consequently, the importance of natural and responsive arm dynamics for efficient and safe ambulation may have significant implications for persons with upper limb loss when not using a prosthesis or only wearing a prosthesis for specific daily activities. Whereas the vast majority of research on upper limb prostheses users has focused on functional use (e.g., reaching and grasping), little attention has been paid to their gait and standing balance characteristics. Consequently, the impact of upper limb loss on walking and standing, particularly in relation to the ability to avoid a fall, remains poorly understood. In light of the importance of arms in maintaining upright balance, we hypothesize that individuals with upper limb loss will exhibit altered ambulatory characteristics compared to able-bodied persons that will create instability and increase their risk of falls and fall-related injuries. Anecdotal evidece from clinicians has supported this hypothesis. Therefore, the primary objective of this project is to explore the impact of upper limb loss on the risk of falls and characteristics of gait and standing balance. To achieve this objective, qualitative and biomechanical data will be collected on individuals with upper limb loss. Qualitative data on etiology, mobility and balance confidence, and fall history will be collected with a questionnaire on individuals with unilateral r bilateral upper limb loss at or proximal to the level of the wrist. The questionnaire will be administered via the internet, telephone interviews, and hardcopy format. Biomechanical data of steady-state gait and standing balance will be collected on upper limb prosthesis users with unilateral limb loss above and below the elbow while: 1) using their current prosthesis, 2) not using a prosthesis, and 3) using an experimental mock (i.e., nonfunctional) prosthesis that matches the inertial properties of the sound limb. Observed biomechanical data will include those previously shown to be associated with fall risk and instability in elderly and other pathological populations prone to unsteadiness. Within-group differences will be analyzed through appropriate repeated measures statistical methods and regression analysis will be applied to develop a predictive model for falls in individuals with upper limb loss. As there is a dearth of information available on the impact of upper limb loss on falls and characteristics of walking and standing, results from this project will provide much-needed insight into this topic and quantify an undocumented health hazard to this population. Subsequent studies will then focus on identifying the underlying mechanisms of instability in upper limb prosthesis users. The long term goal is to develop effective rehabilitation strategies and enhanced technology (e.g., improved prosthesis designs) that facilitate efficient and safe movement and lead to reduced falls, increased daily participation, and an improved quality of life.

描述（由申请人提供）： 自然手臂动力学在行走过程中起着至关重要的作用，特别是在面对突然扰动时确保高效且稳定的步行并避免跌倒。因此，已经观察到在健全步态过程中对手臂挥杆的限制，以增加代谢成本，损害横向稳定性和中断自然步行动力学。重要的是，逮捕秋季机智的武器是避免人身伤害的常见策略，跌倒在老年人中造成97％的上肢骨折，而直接影响直接影响导致的手腕骨折的76％ 手。因此，在不使用假体或仅在特定的日常活动中佩戴假肢时，自然和响应型手臂动力学对高效和安全的行动的重要性可能对上肢损失的人产生重大影响。尽管用户对上肢假体的绝大多数研究都集中在功能用途（例如，到达和掌握）上，但对其步态和站立平衡特征的关注很少。因此，上肢损失对步行和站立的影响，尤其是与避免跌倒的能力有关的影响仍然很少。鉴于 武器在保持直立平衡方面的重要性，我们假设上肢损失的人与能够造成不稳定并增加跌倒和跌倒相关伤害的能力的人相比会显示出改变的卧床特征。临床医生的轶事持续性支持了这一假设。因此，该项目的主要目的是探讨上肢损失对步态和站立平衡特征的风险的影响。为了实现这一目标，将对上肢损失的个体收集定性和生物力学数据。关于病因，流动性和平衡信心以及秋季历史的定性数据将收集有关单侧双侧上肢损失或靠近手腕水平的个体的个体的问卷。问卷将通过互联网，电话采访和硬拷贝格式进行管理。稳态步态和站立平衡的生物力学数据将在上肢假体使用者上收集，肘部上方和下方的肢体损失损失上方和下方是：1）使用它们的当前假体，2）不使用假体，3）使用实验模拟（即，即非功能性），与声音限制的局部性相匹配。观察到的生物力学数据将包括先前证明的与老年人和其他病理性人群的跌倒风险和不稳定的不稳定有关的数据。将通过适当的重复测量统计方法分析组内差异，并将应用回归分析来开发上肢损失个体跌倒的预测模型。由于缺乏有关上肢损失对跌倒的影响以及步行和站立特征的影响，该项目的结果将为该主题提供急需的见解，并量化对该人群的无证件健康危害。然后，随后的研究将集中于识别上肢假体使用者中不稳定的潜在机制。长期目标是制定有效的康复策略和增强技术（例如改进的假体设计），以促进高效且安全的运动，并导致下降，日常参与和改善的生活质量。