Improving Dynamic Walking Stability in Traumatic Amputees

提高创伤性截肢者的动态行走稳定性

基本信息

批准号：
8431350
负责人：
Jonathan B Dingwell
金额：
$ 23.48万
依托单位：
UNIVERSITY OF TEXAS AT AUSTIN
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-01-15 至 2014-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8431350
关键词：
Accidental Injury Address Adopted Affect Age Amputation Amputees Balance training Behavior Biomechanics Cessation of life Clinical Crowding Data Distal Elderly Engineering Environment Equilibrium Event Evidence based treatment Exhibits Fall prevention Feedback Foundations Gait Goals Health Healthcare Healthy People 2010 Height Hip Fractures Human Impairment Injury Intervention Knowledge Laboratories Lateral Lead Leg Lower Extremity Measures Mechanics Modeling Motor Movement Muscle Patient Monitoring Patient Participation Patients Performance Physical activity Poaceae Population Populations at Risk Preventive Intervention Prosthesis Protocols documentation Public Health Randomized Recovery Rehabilitation therapy Relative (related person)Resources Sensory Speed Stroke Surface Testing Therapeutic Intervention Time Training Training Programs Translating Traumatic Amputation Traumatic Brain Injury Vision Visual Walking Weight Work active control base clinical practice compare effectiveness conventional therapy cost design experience fall risk falls fear of falling improved injury prevention kinematics limb amputation neuromuscular novel older patient patient population response somatosensory standard care therapy design treatment strategy treatment trial virtual virtual reality visual feedback

项目摘要

DESCRIPTION (provided by applicant): Walking is an extremely important and common daily activity. Many locomotor impairments increase people's risk of falling. The total costs of all fall-related injuries may reach $43.8 billion by 2020. As many as 60% of patients with lower extremity amputation fall each year. Falls are especially problematic for young patients with traumatic amputation, who fall slightly more than older patients. Most people fall while they are walking. Also, very limited scientific evidence exists to guide design of interventions to improve walking function in patients with amputation. Thus, there is a clear need to better understand how patients with lower limb amputation respond to ecologically relevant perturbations, to identify the biomechanical and neuromuscular strategies these patients use to recover balance after being perturbed, and to develop effective evidence based treatment strategies to help these patients improve their walking stability. Our lab has developed novel engineering approaches to measure walking stability that directly quantify how humans respond to small perturbations. The primary goal of this study is to develop interventions to help prevent falls. This requires intervening before the fall itself occurs. While falls themselves are very elusive events, significant stumbles are very common. In the elderly, stumbling or tripping causes more than half of all falls. Therefore, stumbling is one of the primary precursors to falling. Stumbles often lead to fear of falling, excessive caution, and decreased physical activity. Surprisingly, however, no study has quantified stumbling responses in patients with lower limb amputation. For this project, we will first determine how patients with trans-tibial amputation respond to small, continuous pseudo-random visual or mechanical perturbations, similar to those they might experience walking outdoors over uneven terrain or in crowded public places. We will also directly test the common clinical assumption that these patients rely more heavily on vision because of their loss of distal somatosensory feedback. Second, we will determine how patients with trans-tibial amputation respond to large discrete mechanical perturbations during walking, such as they might experience when tripping over a curb or stepping in a pothole. From these data, we will identify specific biomechanical and neuromuscular strategies amputees use to recover balance after they stumble. Finally, we will determine if targeted virtual reality based gait training is more successful than conventional therapy for improving walking stability in patients with trans-tibial amputation. A fully immersive virtual environment will allow us to apply highly controlled and ecologically relevant perturbations, which we anticipate will generalize more readily to real world walking. This study will apply novel experimental and rigorous analytical approaches to significantly improve our understanding of how patients with amputation respond to perturbations. We will translate this knowledge into clinical practice by developing rehabilitation interventions based on our scientific findings. Finally, this work will provide a scientific basis for developing better interventions to improve walking function in populations with other walking related impairments.

描述（由申请人提供）：步行是一项极其重要且常见的日常活动。许多运动障碍会增加人们跌倒的风险。到 2020 年，所有跌倒相关伤害的总费用可能达到 438 亿美元。每年有多达 60% 的下肢截肢患者跌倒。对于创伤性截肢的年轻患者来说，跌倒尤其成问题，他们比老年患者跌倒的次数略多。大多数人在走路时都会摔倒。此外，指导改善截肢患者步行功能的干预措施设计的科学证据非常有限。因此，显然需要更好地了解下肢截肢患者如何应对生态相关的扰动，确定这些患者在受到扰动后用于恢复平衡的生物力学和神经肌肉策略，并制定有效的基于证据的治疗策略来帮助这些患者患者行走稳定性得到提高。我们的实验室开发了新颖的工程方法来测量行走稳定性，直接量化人类对小扰动的反应。这项研究的主要目标是制定干预措施来帮助预防跌倒。这需要在跌倒发生之前进行干预。虽然跌倒本身是非常难以捉摸的事件，但严重的绊倒却很常见。对于老年人来说，一半以上的跌倒都是由绊倒或绊倒造成的。因此，绊倒是跌倒的主要先兆之一。跌倒常常导致害怕跌倒、过度谨慎以及体力活动减少。然而，令人惊讶的是，没有研究量化下肢截肢患者的绊倒反应。在这个项目中，我们将首先确定经胫骨截肢的患者如何应对小的、连续的伪随机视觉或机械扰动，类似于他们在不平坦的地形或拥挤的公共场所户外行走时可能遇到的扰动。我们还将直接测试常见的临床假设，即这些患者由于失去远端体感反馈而更加依赖视觉。其次，我们将确定经胫骨截肢的患者在行走过程中如何应对较大的离散机械扰动，例如他们在被路缘绊倒或踏入坑洼时可能会遇到的情况。根据这些数据，我们将确定截肢者在跌倒后恢复平衡时使用的特定生物力学和神经肌肉策略。最后，我们将确定基于虚拟现实的有针对性的步态训练是否比传统疗法更成功地改善经胫骨截肢患者的行走稳定性。完全沉浸式的虚拟环境将使我们能够应用高度受控且与生态相关的扰动，我们预计这将更容易推广到现实世界的行走中。这项研究将应用新颖的实验和严格的分析方法来显着提高我们对截肢患者如何应对扰动的理解。我们将根据我们的科学发现制定康复干预措施，将这些知识转化为临床实践。最后，这项工作将为开发更好的干预措施提供科学依据，以改善患有其他步行相关障碍的人群的步行功能。