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）： 自然的手臂动力学在行走过程中发挥着至关重要的作用，特别是在确保高效稳定的行走并避免在面临突然扰动时跌倒。因此，已观察到，在健全步态期间限制手臂摆动会增加代谢成本，损害横向稳定性并干扰自然行走动力。重要的是，在跌倒时伸出双臂阻止是避免身体受伤的常见策略，老年人中 97% 的上肢骨折是由跌倒造成的，而 76% 的腕部骨折是由于直接撞击手腕而导致的。 手。因此，自然且反应灵敏的手臂动力学对于高效和安全行走的重要性可能对不使用假肢或仅佩戴假肢进行特定日常活动时上肢丧失的人产生重大影响。尽管绝大多数关于上肢假肢使用者的研究都集中在功能使用（例如，伸手和抓握）上，但很少关注他们的步态和站立平衡特征。因此，上肢丧失对行走和站立的影响，特别是与避免跌倒的能力有关的影响，仍然知之甚少。鉴于 由于手臂在保持直立平衡方面的重要性，我们假设与健全人相比，上肢丧失的人会表现出改变的行走特征，这将造成不稳定并增加跌倒和跌倒相关伤害的风险。临床医生的轶事证据支持了这一假设。因此，该项目的主要目标是探讨上肢丧失对跌倒风险以及步态和站立平衡特征的影响。为了实现这一目标，将收集上肢丧失患者的定性和生物力学数据。将通过对手腕水平或接近手腕水平的单侧或双侧上肢丧失的个体进行问卷调查，收集有关病因、活动性和平衡信心以及跌倒史的定性数据。调查问卷将通过互联网、电话访谈和硬拷贝形式进行。将收集肘部上方和下方单侧肢体缺失的上肢假肢使用者的稳态步态和站立平衡的生物力学数据，同时：1) 使用当前假肢，2) 不使用假肢，3) 使用实验模拟（即非功能性）假肢与健全肢体的惯性特性相匹配。观察到的生物力学数据将包括先前显示与老年人和其他容易不稳定的病理人群的跌倒风险和不稳定性相关的数据。将通过适当的重复测量统计方法来分析组内差异，并应用回归分析来开发上肢丧失个体跌倒的预测模型。由于缺乏关于上肢丧失对跌倒的影响以及行走和站立特征的信息，该项目的结果将为该主题提供急需的见解，并量化对该人群的未记录的健康危害。随后的研究将集中于确定上肢假肢使用者不稳定的潜在机制。长期目标是制定有效的康复策略和增强技术（例如改进的假肢设计），以促进高效和安全的运动，减少跌倒，增加日常参与度并提高生活质量。