Locomotor Response of Persons with Upper Limb Loss to Treadmill Perturbations

上肢丧失者对跑步机扰动的运动反应

• 批准号: 10223463
• 负责人: Matthew J. Major
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10223463
• 关键词: Address; Affect; Award; Behavior; Biomechanics; Body mass index; Burn injury; Custom; Data; Economic Burden; Educational Intervention; Electromyography; Epidemiology; Equilibrium; Funding; Future; Gait; Gender; Health; High Prevalence; Impairment; Individual; Infrastructure; Integrated Health Care Systems; Intervention; Investigation; Knowledge; Lead; Left; Length; Limb Prosthesis; Limb structure; Lower Extremity; Measures; Methods; Motion; Multi-site clinical study; Muscle; Musculoskeletal Equilibrium; Optics; Outcome; Participant; Patient Care; Patients; Persons; Physiologic pulse; Pilot Projects; Posture; Preparation; Prevalence; Prosthesis; Public Health; Quality of life; Recovery; Rehabilitation therapy; Reporting; Research; Side; System; Technology; Time; Treatment Efficacy; Upper Extremity; Veterans; Walking; Wireless Technology; Work; Wrist; arm; balance prosthesis; base; cost; epidemiology study; equilibration disorder; experience; fall injury; fall risk; falls; improved; individual response; kinematics; limb loss; programs; prosthesis wearer; response; sensor; sound; spatiotemporal; standard of care; treadmill; walking stability

The primary aim of this pilot study is to characterize the proactive and reactive locomotor response of Veterans with upper limb loss (ULL) to a trip during walking. Our recent VA-funded (RX001388, RX001322) investigations have suggested that persons with ULL experience a high prevalence of falls and demonstrate postural control mechanisms that may impair stability. Specifically, nearly half of individuals with ULL at or proximal to the wrist level experience at least one fall per year and almost a third will experience two or more falls. Further, use of a prosthesis increases the likelihood of falling by six times, 25% of reported falls resulted from tripping, and nearly a third of individuals who experience a fall suffer a fall-related injury. Falls can have considerable economic burden on the VHA and lead to long-term diminished quality of life. Our biomechanical studies suggest that persons with unilateral ULL display greater postural sway during standing than able-bodied individuals which increases when wearing a prosthesis, and right/left asymmetry in locomotor stability dynamics that may [increase the risk of falling toward the impaired limb side and during sound limb side strides]. These findings emphasize the need for additional research to better understand the mechanisms Veterans with ULL use to control balance and how [wearing a] prosthesis [affects] these strategies. As our previous research was concerned with steady- state characterization of postural control, we now plan to build on this work by studying the effects of ULL and [wearing a] prosthesis on locomotor stability when responding to a trip disturbance during walking. In this context, locomotor stability is defined as the ability to recover from a perturbation and return to steady-state gait. We will address the study aims by analyzing trip-induced proactive and reactive locomotor strategy differences in two study comparisons: 1) Veterans with unilateral transradial level ULL against matched able-bodied controls [(with and without one arm bound)], and 2) Veterans with unilateral transradial ULL when wearing their customary prosthesis against not wearing their prosthesis. Controlled, yet unexpected, simulated trips will be delivered through our custom-built treadmill which permits programmable belt velocity disturbances and allows participants to continue walking following recovery. We will characterize the proactive and reactive locomotor [stability mechanisms] through a set of biomechanical (spatiotemporal, angular momentum, arm and trunk kinematics, recovery step length and time) and electromyography (upper and lower limb muscle activation timing and effort) variables. Biomechanical variables will be quantified using an optical motion capture system, and electromyography will be collected with a wireless sensor system. All data will be synchronized with each other and a time pulse denoting the onset of the treadmill perturbation. We expect that Veterans with ULL will demonstrate [altered] locomotor stability [mechanisms] compared to controls, and [these differences will exist between wearing and not wearing] their customary prosthesis. Results from this study will help us characterize the underlying mechanisms of locomotor stability in Veterans with ULL and identify the factors associated with their increased prevalence of trip-related falls. Such knowledge is a critical first step to addressing this public health problem through stability-targeted rehabilitation interventions aimed at reducing falls, fall-related injuries, and associated VHA costs in this Veteran patient group. We will use the outcomes from this pilot study to guide future VA Merit Award proposals to [develop and] assess [physical training] intervention methods and [wearable and prosthetic technology to improve stability in Veterans with ULL]. The VHA is an ideal venue to pursue this work as one of its main priorities is to elevate the standard-of-care for Veterans with limb loss.

这项试点研究的主要目的是表征退伍军人的主动和反应性运动反应 上肢丧失（ULL）导致步行过程中绊倒。我们最近由 VA 资助的（RX001388、RX001322）调查 研究表明，患有 ULL 的人跌倒的几率很高，并且表现出姿势控制能力 可能损害稳定性的机制。具体来说，近一半的 ULL 患者位于或接近手腕 每年至少经历一次跌倒，几乎三分之一的人会经历两次或两次以上跌倒。此外，使用 假肢使跌倒的可能性增加了六倍，据报道，25%的跌倒是由于绊倒造成的，几乎 三分之一跌倒的人遭受与跌倒相关的伤害。跌倒可带来可观的经济损失 VHA 的负担并导致长期生活质量下降。我们的生物力学研究表明 患有单侧 ULL 的人在站立时比身体健全的人表现出更大的姿势摇摆 佩戴假肢时会增加，运动稳定性动力学中的左右不对称可能会增加 向受损肢体一侧和在健全的肢体一侧迈步时跌倒的风险]。这些发现强调 需要进行额外的研究以更好地了解患有 ULL 的退伍军人用来控制平衡的机制 以及[佩戴]假肢如何[影响]这些策略。由于我们之前的研究关注的是稳定 姿势控制的状态表征，我们现在计划通过研究 ULL 和 [佩戴]假肢在应对行走过程中的绊倒干扰时对运动稳定性的影响。在此背景下， 运动稳定性定义为从扰动中恢复并恢复到稳态步态的能力。 我们将通过分析旅行引起的主动和反应性运动策略差异来解决研究目标 两项研究比较：1) 单侧经桡动脉水平 ULL 的退伍军人与匹配的健全对照 [（有或没有束缚一只手臂）]，以及 2) 佩戴惯用服装时患有单侧经桡动脉 ULL 的退伍军人 假肢反对不戴假肢。将提供受控但意外的模拟行程 通过我们定制的跑步机，它允许可编程的皮带速度扰动，并允许参与者 康复后继续行走。我们将描述主动和反应运动[稳定性 机制]通过一组生物力学（时空、角动量、手臂和躯干运动学、 恢复步长和时间）和肌电图（上肢和下肢肌肉激活时间和力度） 变量。生物力学变量将使用光学运动捕捉系统进行量化，并且 肌电图将通过无线传感器系统收集。所有数据将相互同步 以及表示跑步机扰动开始的时间脉冲。我们预计患有 ULL 的退伍军人将 与对照组相比，展示[改变的]运动稳定性[机制]，并且[这些差异将存在 在佩戴和不佩戴之间]他们习惯的假肢。这项研究的结果将帮助我们描述 患有 ULL 的退伍军人运动稳定性的潜在机制，并确定与 与旅行相关的跌倒发生率增加。这些知识是解决这一问题的关键的第一步 通过以稳定性为目标的康复干预措施来解决健康问题，旨在减少跌倒、跌倒相关伤害， 以及该退伍军人患者群体的相关 VHA 费用。我们将利用这项试点研究的结果来指导 未来 VA 优异奖提案旨在[开发和]评估[体育训练]干预方法和[可穿戴设备 和假肢技术，以提高 ULL 退伍军人的稳定性]。 VHA 是实现这一目标的理想场所 其主要优先事项之一是提高肢体丧失退伍军人的护理标准。