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; 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.

这项试验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 在步行期间，上肢损失（ULL）到旅行。我们最近获得的VA资助（RX001388，RX001322）调查 已经提出，有ULL的人经历了很高的跌倒率并表现出姿势控制 可能会损害稳定性的机制。具体而言，将近一半的人在手腕上或近端 水平经验至少每年秋天一个，几乎三分之一将体验到两个或更多的跌倒。此外，使用 假体增加了下降的可能性六倍，报告的跌倒的25％是由于绊倒而导致的，几乎 三分之一的经历秋天的人遭受了与跌倒有关的伤害。瀑布可以拥有相当大的经济 VHA负担，导致长期降低生活质量。我们的生物力学研究表明 单方面ull的人在站立期间表现出比健美的人更大的姿势摇摆 佩戴假体和运动稳定性动力学中的右/左不对称时会增加 朝着肢体侧面受损的风险以及在声音肢体侧向走向时的风险]。这些发现强调 需要进行额外研究以更好地了解使用ULL的退伍军人来控制平衡的机制 以及[戴]假体[影响]这些策略。因为我们以前的研究与稳定有关 国家对姿势控制的表征，我们现在计划通过研究ULL和 [戴上]在行走过程中回应旅行障碍时，关于运动稳定的假体。在这种情况下， 运动稳定性定义为从扰动中恢复并返回稳态步态的能力。 我们将通过分析Trip引起的主动和反应性运动策略差异来解决研究目标 在两个研究比较中：1）具有单方面跨性别水平的退伍军人针对匹配的身体对照 [（带有和不带一个手臂绑定）]，以及2）在穿着习惯时具有单侧跨性别的退伍军人 假体反对不穿假肢。将交付受控但出乎意料的模拟旅行 通过我们的定制跑步机，允许可编程的皮带速度干扰并允许参与者 恢复后继续走路。我们将表征主动和反应性运动[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（上肢和下肢的肌肉激活时间和努力） 变量。生物力学变量将使用光运动捕获系统进行量化，并且 肌电图将通过无线传感器系统收集。所有数据将彼此同步 以及表示跑步机摄动的开始的时间脉冲。我们希望有ull的退伍军人会 与对照相比，证明[改变]运动稳定性[机制]，[这些差异将存在 在穿着和不穿的习惯假体之间。这项研究的结果将帮助我们描述 具有ULL的退伍军人的运动稳定性的基本机制，并确定与 他们增加了与跳闸有关的跌倒。这种知识是向公众致辞的关键第一步 通过以稳定性为目标的康复干预措施，旨在减少跌倒，与下降有关的伤害， 和相关的VHA成本在这个资深患者组中。我们将使用此试点研究的结果来指导 未来的VA优异奖提案，以[开发和]评估[体育培训]干预方法和[可穿戴 和假肢技术，以提高ULL退伍军人的稳定性]。 VHA是追求这一点的理想场所 作为其主要优先事项之一是提高肢体损失的退伍军人的护理标准。