Can Sensory Feedback Training Improve the Biomechanical and Metabolic Effects of Using Passive or Powered Lower Limb Prostheses During Walking for Veterans with Transtibial Amputations?

感觉反馈训练能否改善小腿截肢退伍军人在行走过程中使用被动或动力下肢假肢的生物力学和代谢效应？

• 批准号: 10653769
• 负责人: Alena Grabowski
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10653769
• 关键词: Activities of Daily Living; Address; Adopted; Adult; Affect; Amputation; Ankle; Back Pain; Biomechanics; Computers; Degenerative polyarthritis; Development; Diabetes Mellitus; Equilibrium; Feedback; Health; Hip Joint; Impairment; Injury; Joints; Knee; Knee joint; Leg; Limb Prosthesis; Lower Extremity; Measures; Mechanics; Metabolic; Muscle; Obesity; Pain in lower limb; Persons; Phase; Physical Function; Physical activity; Prosthesis; Prosthesis Design; Quality of life; Reaction; Rehabilitation therapy; Research; Rest; Risk; Techniques; Technology; Time; Training; Veterans; Walking; Work; ankle joint; ankle prosthesis; comorbidity; computer monitor; cost; functional disability; improved; improved functioning; limb amputation; osteoarthritis pain; pain reduction; post stroke; powered prosthesis; prosthetic foot; rehabilitation research; rehabilitation strategy; response; sensory feedback; treadmill; visual feedback

[Due to the functional impairments caused by a lower limb amputation, it is essential to determine the benefits of rehabilitation strategies such as real-time visual feedback training. Such training could allow Veterans with transtibial amputations (TTAs) to better utilize their prostheses and regain the greatest possible level of function. It is not clear how much the prosthetic device (passive-elastic prosthetic foot versus battery- powered ankle-foot prosthesis) and/or the user’s response to the prosthesis contribute to the biomechanical and metabolic effects of using these prostheses during walking. Better use of a prosthesis due to targeted real- time visual feedback training could enhance rehabilitation, improve function and reduce asymmetric biomechanics, which in turn could reduce common comorbidities such as osteoarthritis, leg and back pain, and indirectly, diabetes in Veterans with TTAs. The purpose of the proposed project is to systematically establish the metabolic and biomechanical effects of targeted real-time visual feedback training of peak propulsive ground reaction force (GRF) on the biomechanics, metabolic costs, and muscle activity of Veterans with TTAs using their own passive-elastic prosthetic foot and a battery-powered ankle-foot prosthesis. The results of our research could enhance the use of prosthetic technology to improve the rehabilitation and function of Veterans with lower limb amputations. Previous studies suggest that use of passive-elastic and/or powered ankle-foot prostheses may not optimize the function of Veterans with TTAs during walking. Targeted, real-time visual feedback training of peak propulsive ground reaction forces increased propulsion and improved walking function in older (>65 years) and post-stroke adults, who typically have impaired ankle power. To our knowledge, no research has addressed how visual feedback of peak propulsive force affects the use of passive-elastic or powered ankle- foot prostheses by people with TTAs. In the proposed research, we will determine the underlying metabolic costs, biomechanics, stability, and muscle activity resulting from targeted real-time visual feedback training of peak propulsive force to identify how Veterans with a TTA benefit from more effective use of a passive-elastic prosthesis and/or a battery-powered ankle-foot prosthesis and to determine if the addition of mechanical power provided by a battery-powered ankle-foot prosthesis can further enhance the function of Veterans with unilateral TTAs during walking. 30 Veterans with unilateral TTAs will use their own passive-elastic prosthesis both with and without visual feedback training during level-ground walking, while we measure their metabolic costs and biomechanics. Then, they will use a powered ankle-foot prosthesis (emPOWER, BiONX, Ottobock) both with and without visual feedback training during level-ground walking, while we measure their metabolic costs and biomechanics. With each prosthesis, subjects will walk at 1.25 m/s on a dual-belt force-measuring treadmill 1) with no visual feedback, and then with real-time visual feedback of: 2) peak propulsive force from the “no feedback” condition, 3) +20% greater peak propulsive force, and 4) +40% greater peak propulsive force. During these visual feedback trials, we will ask subjects to match the peak propulsive force displayed on a computer screen with their affected leg. We will also ask subjects to: 5) match symmetric visual feedback of the peak propulsive force from both legs. We will determine if Veterans with TTAs utilizing real-time visual feedback training of peak propulsive force can improve metabolic costs, biomechanical symmetry, and dynamic stability/balance, while using their own passive-elastic prosthesis or a powered ankle-foot prosthesis. We will also establish if Veterans with TTAs can retain the metabolic and biomechanical benefits elicited by real-time visual feedback training once that feedback is removed. Results from the proposed project will be used to inform rehabilitation strategies and prosthetic design, which could ultimately improve health, maximize function, and improve quality of life for Veterans with TTAs.]

[由于下肢截肢引起的功能障碍，必须确定 康复策略的好处，例如实时视觉反馈培训。这样的培训可以允许 具有跨位截肢（TTA）的退伍军人，以更好地利用其假肢并保持最大可能 功能水平。目前尚不清楚假肢设备多少（被动弹性假肢与电池 - 脚踝脚的动力假体）和/或用户对假体的反应有助于生物力学 以及在步行过程中使用这些假体的代谢作用。由于有针对性的实地，更好地使用假体 时间视觉反馈训练可以增强康复，提高功能并减少不对称 生物力学反过来可以减少常见合并症，例如骨关节炎，腿部和背痛，以及 间接地，有TTA的退伍军人中的糖尿病。拟议项目的目的是系统地建立 峰值推进的目标实时视觉反馈训练的代谢和生物力学效应 TTA的退伍军人的生物力学，代谢成本和肌肉活动的地面反作用力（GRF） 使用自己的被动弹性假肢脚和电池供电的脚踝假体。我们的结果 研究可以增强假肢技术来改善退伍军人的康复和功能 下肢截肢。 先前的研究表明，使用被动弹性和/或动力脚踝脚步可能不会 在步行过程中优化用TTA的退伍军人的功能。有针对性的实时视觉反馈培训 峰值推进地面反作用力增加了推进力和改善的年龄较大的步行功能（> 65 多年）和中风后成年人，通常会损害脚踝的力量。据我们所知，没有研究 解决了峰值推进力的视觉反馈如何影响被动弹性或动力的脚踝的使用 TTA的人的脚步假肢。在拟议的研究中，我们将确定潜在的代谢 成本，生物力学，稳定性和肌肉活动是由针对性的实时视觉反馈培训产生的 峰值推进力以确定具有TTA的退伍军人如何受益于更有效的被动弹性 假体和/或电池供电的脚踝脚步假体，并确定是否增加了机械能力 由电池供电的脚踝假肢提供的可以进一步增强退伍军人的功能 步行过程中的单方面TTA。 30个具有单方面TTA的退伍军人将使用自己的被动弹性假体 在地面步行期间，无论是否有视觉反馈训练，我们都会测量其代谢 成本和生物力学。然后，他们将使用一个动力的脚踝假体（Empower，Bionx，Ottobock） 在地面步行期间，无论是否有视觉反馈训练，我们都会测量其代谢 成本和生物力学。每次假体，受试者将以1.25 m/s的速度行走在双皮测量上 跑步机1）没有视觉反馈，然后具有实时视觉反馈：2） “无反馈”条件，3） +峰值推进力大20％，4） +40％的峰值推进力 力量。在这些视觉反馈试验中，我们将要求受试者与显示的峰值推进力匹配 带有影响腿的计算机屏幕。我们还将要求受试者：5）匹配对称的视觉反馈 双腿的峰值推进力。我们将确定使用实时视觉的退伍军人是否使用TTA 峰值推进力的反馈训练可以提高代谢成本，生物力学对称性和 动态稳定性/平衡，同时使用自己的被动弹性假体或脚踝脚的假体。 我们还将确定具有TTA的退伍军人是否可以保留由 一旦取消了反馈，实时视觉反馈培训。拟议项目的结果将是 用于为康复策略和假肢设计提供信息，最终可以改善健康 功能，改善TTA的退伍军人的生活质量。]