How Do Lower Limb Prosthetic Stiffness and Power Affect the Biomechanics, Metabolic Costs, and Satisfaction of Veterans with Transtibial Amputations DuringWalking?

下肢假肢刚度和力量如何影响小腿截肢退伍军人步行时的生物力学、代谢成本和满意度？

• 批准号: 10652963
• 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/10652963
• 关键词: Affect; Amputation; Ankle; Back Pain; Biological; Biomechanics; Categories; Computer software; Degenerative polyarthritis; Diabetes Mellitus; Felis catus; Germany; Goals; Health; Health Care Costs; Impairment; Individual; Joints; Kinetics; Knee; Lead; Leg; Limb Prosthesis; Lower Extremity; Manufacturer Name; Materials Testing; Measures; Mechanics; Metabolic; Movement; Muscle; Obesity; Osteoporosis; Output; Pain in lower limb; Participant; Persons; Phase; Physical Function; Physical activity; Property; Prosthesis; Prosthesis Design; Quality of life; Questionnaires; Recommendation; Recovery; Rehabilitation therapy; Resources; Risk; Savings; Series; Services; Shapes; Shoes; Speed; Technology; Testing; Time; Torque; Torsion; Veterans; Walking; Work; ankle prosthesis; base; comorbidity; cost; evidence base; foot; functional disability; functional restoration; improved; improved functioning; in vivo; kinematics; mechanical energy; pain reduction; powered prosthesis; prosthesis control; prosthetic foot; rehabilitation research; research and development; satisfaction; treadmill; walking speed

Previous studies suggest that use of the recommended prosthetic foot stiffness category and/or ankle power output setting may not optimize the function of Veterans with transtibial amputations (TTAs). Due to the functional impairments and lifetime of healthcare costs incurred by Veterans with TTAs, it is vital to determine how different prosthetic foot and ankle properties/parameters such as passive-elastic prosthetic foot stiffness and battery-powered prosthetic ankle power output affect the metabolic cost and biomechanics of Veterans with TTAs. Further, determining the optimal prosthetic foot stiffness and/or power output could dramatically improve the function of people with TTAs, which would promote increased physical activity, while reducing pain and the risk of comorbidities. Veterans with TTAs typically use a passive-elastic prosthetic foot such as the Össur Low Profile Vari-flex with Evo (LP) with a stiffness category based on manufacturer-recommendations, user body mass, and anticipated activity level. Previous evidence demonstrates that Veterans with TTAs using the recommended passive-elastic prosthetic foot stiffness category for walking have greater metabolic demands, asymmetric biomechanics, leg and back pain, and discomfort compared to non-amputees. Further, some Veterans use a battery-powered ankle-foot prosthesis such as the Ottobock BiOM. [The Össur Low Profile Vari-flex with Evo (LP) is the only passive-elastic prosthetic foot that integrates with the BiOM. The LP is utilized beneath (in-series with) the BiOM with a stiffness category based on manufacturer-recommendations, user body mass and activity level. Then, the BiOM is tuned by adjusting nine different parameters within the prosthesis using different software settings so that the combination of the user and prosthesis produce net positive prosthetic ankle work equivalent to average non-amputee net positive ankle work within two standard deviations (SD) of the mean. Use of BiOM has resulted in normative metabolic costs and biomechanics for people with TTAs compared to non-amputees, but one study found that use of the BiOM with a recommended LP prosthetic foot stiffness category and prosthetic power output setting did not elicit differences in metabolic cost at preferred walking speeds compared to use of participants’ own passive-elastic prosthesis.] We will systematically assess how prosthetic foot stiffness and power output affect physical function in Veterans with TTAs. First, we will quantify prosthetic and torsional stiffness (force/displacement or torque/angle) values of LP prostheses. Determining stiffness values (in kN/m and kN·m/rad) for a given passive-elastic prosthetic foot stiffness category is essential for deriving the dynamic biomechanical function of prosthetic feet. Then, we will systematically measure and compare the metabolic cost, biomechanics, muscle activity, and satisfaction resulting from using the LP passive-elastic prosthetic foot alone with four stiffness categories, and the BiOM battery-powered ankle-foot prosthesis combined with four LP prosthetic foot stiffness categories and three different magnitudes of prosthetic ankle power output during walking over a range of speeds. Our results will provide a mechanistic understanding of prosthetic stiffness and power to inform prosthetic design and control, which will improve and expedite rehabilitation of Veterans with TTAs and the quality of services provided by the VA, while saving time, money, and resources. By improving prosthetic design and control, our results could ultimately allow Veterans with TTAs to regain the greatest possible level of physical function, improve their health, maximize their recovery and rehabilitation, facilitate their return to work/duty, and potentially improve their quality of life. Long-term goals for prosthetic design should include “smarter” prostheses that can change stiffness dynamically, generate net positive mechanical work, and dissipate mechanical work. However, a critical barrier to developing such advanced prostheses is our lack of a fundamental understanding of the effects of different prosthetic foot stiffness and power output on the metabolic costs, biomechanics, and satisfaction of Veterans with TTAs during level-ground walking.

先前的研究表明，使用推荐的假肢足僵硬类别和/或踝关节 由于以下原因，功率输出设置可能无法优化经过胫骨截肢 (TTA) 的退伍军人的功能。 具有 TTA 的退伍军人所产生的功能障碍和终生医疗费用，确定这一点至关重要 假脚和脚踝的不同特性/参数（例如被动弹性假脚刚度）如何 电池供电的假肢踝关节功率输出会影响退伍军人的代谢成本和生物力学 此外，通过 TTA 可以显着确定最佳的假肢刚度和/或功率输出。 改善 TTA 患者的功能，这将促进增加体力活动，同时减少疼痛 患有 TTA 的退伍军人通常使用被动弹性假足，例如 Össur Low Profile Vari-flex with Evo (LP) 具有基于制造商建议的刚度类别， 用户体重和预期活动水平表明，有 TTA 的退伍军人使用。 推荐用于步行的被动弹性假足硬度类别具有更大的新陈代谢 与非截肢者相比，需求、不对称的生物力学、腿部和背部疼痛以及不适。 一些退伍军人使用电池供电的踝足假肢，例如 Ottobock BiOM [The Össur Low]。 Profile Vari-flex with Evo (LP) 是唯一与 BiOM 集成的被动弹性假足。 在 BiOM 下方（串联）使用，其刚度类别基于制造商建议， 然后，通过调整九个不同的参数来调整 BiOM。 假肢使用不同的软件设置，以便用户和假肢的结合产生网络 正假肢踝关节功相当于平均非截肢者净正踝关节功，在两个标准内 BiOM 的使用导致了正常的代谢成本和生物力学。 患有 TTA 的人与非截肢者相比，但一项研究发现，使用 BiOM 并推荐 LP 假肢足硬度类别和假肢功率输出设置并未引起代谢差异 与使用参与者自己的被动弹性假肢相比，在首选步行速度下的成本。] 我们将系统地评估假足刚度和功率输出如何影响身体功能 首先，我们将量化假肢和扭转刚度（力/位移或 确定给定 LP 假体的刚度值（以 kN/m 和 kN·m/rad 为单位）。 被动弹性假足刚度类别对于推导动态生物力学功能至关重要 然后，我们将系统地测量和比较代谢成本、生物力学、肌肉。 单独使用具有四种刚度的 LP 被动弹性假足所产生的活动度和满意度 类别，以及 BiOM 电池供电踝足假肢与四个 LP 假足硬度相结合 在一定范围内行走时假肢踝关节功率输出的类别和三种不同幅度 我们的结果将提供对假肢刚度和力量的机械理解，以提供信息。 假肢设计和控制，这将改善和加快退伍军人的康复与 TTA 和 通过改进假肢，提高 VA 提供的服务质量，同时节省时间、金钱和资源。 设计和控制，我们的结果最终可以让具有 TTA 的退伍军人重新获得最大可能的水平 的身体机能，改善他们的健康，最大限度地恢复和康复，促进他们重返社会 工作/职责，并可能提高他们的生活质量，假肢设计的长期目标应包括。 “更智能”的假肢可以动态改变刚度，产生净正机械功，并且 然而，开发这种先进假肢的一个关键障碍是我们缺乏机械功。 基本了解不同假肢刚度和功率输出对假肢的影响 退伍军人在平地行走期间对 TTA 的代谢成本、生物力学和满意度。