Restoring Proprioception to Improve Balance and Gait in Lower-Limb Amputees

恢复本体感觉以改善下肢截肢者的平衡和步态

• 批准号: 9760456
• 负责人: Bailey Anne Petersen
• 金额: $ 3.86万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9760456
• 关键词: Acceleration; Amputation; Amputees; Ankle; Biomimetics; Clinical; Code; Communities; Complex; Development; Electric Stimulation; Environment; Equilibrium; Esthesia; Feedback; Frequencies; Functional disorder; Funding; Gait; Goals; Impairment; Implant; Individual; Joint Prosthesis; Joints; Knee; Knee joint; Lateral; Light; Limb Prosthesis; Lower Extremity; Measurement; Measures; Mechanics; Methods; Modality; Motion; Movement; Nervous system structure; Neurostimulation procedures of spinal cord tissue; Participant; Pathology; Pattern; Perception; Physiologic pulse; Population; Posture; Proprioception; Prosthesis; Proxy; Psychophysics; Reporting; Reproduction; Safety; Sensory; Stimulus; Surface; Tactile; Techniques; Testing; Time; Training; United States National Institutes of Health; Upper Extremity; Walking; Width; ankle joint; epidural space; experimental study; fall risk; falls; improved; improved mobility; indexing; interest; joint mobilization; kinematics; limb amputation; limb movement; motor control; neural patterning; neuroprosthesis; neuroregulation; response; sensor; sensory feedback; spinal nerve posterior root

Abstract Lower-limb amputees can suffer from a wide range of gait impairments, ranging from compensatory movements to a substantially higher fall risk than the average population. This increased fall risk can be partially attributed to reduced or complete lack of tactile and proprioceptive feedback from the prosthetic limb. There has been significant recent interest in providing sensory feedback via sensorized neuroprostheses. However, these studies have primarily focused on restoring tactile feedback in upper-limb amputees. The aim of this study is to provide natural proprioceptive feedback in lower-limb amputees through lumbosacral spinal cord stimulation (SCS). Experiments will be conducted as an addition to an ongoing NIH-funded project using FDA-cleared SCS leads implanted percutaneously into the lateral lumbar epidural space. To determine the parameters required to evoke naturalistic percepts of joint motion, we will first evaluate the effects of stimulus patterning on the naturalness of evoked proprioceptive sensations. Using an adapted cross-modal congruency effect (CCE) test as a proxy for naturalness, we will quantify which stimulation patterns (constant frequency or biomimetic) create a more natural percept, as indicated by a higher CCE score. To evaluate the effect of stimulation on the subject’s ability to incorporate these percepts as proprioception, we will use a variety of stimulation patterns with varying degrees of naturalness and evaluate the proprioceptive accuracy for either static or dynamic percepts. We will also study the effect of evoked proprioceptive sensations on improving gait and function using a sensorized prosthesis to provide real-time feedback about joint angles. We will use both clinical and scientific measures of proprioception and gait function to evaluate the efficacy of stimulation. We hypothesize that more natural sensations of proprioception will provide greater accuracy in clinical tests of proprioception and greater improvements in more complex motor control tasks, such as gait, thereby improving the mobility and safety of lower-limb amputees.

抽象的 下limb截肢者可能遭受各种步态障碍，从 与平均人群相比，补偿性运动的跌倒风险要高得多。这 跌倒风险增加可以部分归因于降低或完全缺乏触觉和 假肢的本体感受反馈。最近对 通过感官反馈通过感官反馈。但是，这些研究有 首先专注于恢复上限截面的触觉反馈。这项研究的目的是 通过腰椎脊柱在下limb截肢者中提供自然的本体感受反馈 绳索刺激（SC）。实验将作为正在进行的NIH资助的补充 使用FDA清除的SCS导线经植入腰椎外侧性硬膜外的项目 空间。为了确定引起自然主义对关节运动的自然主义所需的参数，我们 将首先评估刺激图案对诱发本体感受的自然性的影响 感觉。使用改编的跨模式一致性效应（CCE）测试作为代理 自然，我们将量化哪些刺激模式（恒定频率或仿生） 如CCE评分所表明的那样，创建更自然的感知。评估 刺激该主题将这些感知纳入本体感受的能力，我们将使用 各种自然程度不同的刺激模式，并评估 静态或动态感知的本体感受精度。我们还将研究 诱发了有关使用感官假体提高步态和功能的本体感受的感觉 提供有关关节角度的实时反馈。我们将同时使用临床和科学 本体感受和步态功能的度量以评估刺激的效率。我们 假设更自然的本体感受将提供更高的准确性 本体感受的临床测试和更复杂的运动控制任务的更大改进， 例如步态，从而提高了下limb截肢者的活动性和安全性。