Lower limb prostheses for individuals who carry infants, toddlers, and other loads

适用于携带婴儿、幼儿和其他负载的人员的下肢假肢

• 批准号: 10003046
• 负责人: Glenn Klute
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10003046
• 关键词: Affect; American; Amputation; Amputees; Ankle; Anterior; Back; Biomechanics; Body Weight; Brain; Bulla; Categories; Clinical; Conflict (Psychology); Data; Diabetes Mellitus; Disease; Energy Metabolism; Equilibrium; Etiology; Experimental Designs; Experimental Models; Freedom; Gait; Goals; Heel; Individual; Infant; Inflammation; Injury; Knee; Life; Limb Prosthesis; Limb structure; Lower Extremity; Manufacturer Name; Methods; Modeling; Motor; Muscle; Musculoskeletal; Occupations; Operative Surgical Procedures; Pain; Participant; Patient Self-Report; Patients; Performance; Property; Prosthesis; Randomized; Research; Side; Specific qualifier value; Stress Fractures; Toddler; Veterans; Walking; Weight Gain; Weight-Bearing state; Work; arm; base; experience; experimental study; foot; human subject; improved; innovation; insight; instrument; joint loading; limb amputation; models and simulation; neuromuscular system; prosthetic foot; response; sensor; standard of care; stem; treadmill; volunteer

PROJECT SUMMARY (PUBLIC ABSTRACT) The natural lower limbs provide important biomechanical functions such as body weight support, forward propulsion, and balance control during ambulation. When the loads borne by the lower limbs change, lower limb muscle activation responds accordingly to enable seamless continuation of biomechanical function. These loads can change suddenly, such as when carrying an infant, toddler, or other load like a heavy backpack. For individuals with a lower limb amputation, these sudden changes to weight-bearing loads can be problematic because they can negatively impact walking performance. One reason walking performance may suffer is that the properties of most prosthetic limbs, such as their stiffness, are constant and do not change to suit varying load conditions. Another reason is that the most widely prescribed prosthetic feet do not have motors, sensors, or brain-like controllers that act to replace the neuromuscular system of the amputated limb. Regardless of the reason, no evidence exists to guide prescription practice for veterans who walk with a prosthesis and experience sudden load changes. The proposed research will use experimental and modeling analyses to create guidance for VA clinicians who prescribe prostheses to veterans with a lower limb amputation who frequently carry infants, toddlers or other loads. Our proposed research has two specific aims: Specific Aim 1: Identify the prosthetic foot that results in improved walking performance when veterans with lower limb amputation carry infants, toddlers, or other loads. We propose to conduct a human subject experiment with help of fifteen individuals with below-knee amputations. Study participants will walk on a treadmill with no added load and four added load conditions using a weighted pack (13.6 kg or ~30 lbs) to simulate an infant, toddler, or other load. The four conditions include the pack strapped to their front, their back, and carried with their arms on the intact limb side and the prosthetic limb side. Each participant will wear a usual prosthetic foot, this same foot with a heel-stiffening wedge, the same prosthetic foot but one category stiffness higher, a new-to-market dual keel prosthetic foot intended for load carrying situations, and a powered ankle foot prosthesis. The results from these experiments will aid VA clinicians in specifying the best prosthesis for veterans with lower limb amputations who frequently carry infants, toddlers, or other loads. Specific Aim 2: Identify the sensitivity of muscle contributions to specific biomechanical quantities in response to the different stiffness and loading conditions. We propose to use advanced modeling and simulation analyses to identify how foot stiffness influences individual muscle contributions to specific biomechanical quantities including body weight support, forward propulsion, balance control, energy expenditure, and joint loading for the different loading conditions examined in Aim 1. We will further perform exploratory analyses with increased weight increments to discover the sensitivity of muscle contributions to the biomechanical quantities. We anticipate these results will provide significant insight into these relationships because with our model we can explore a much wider range of conditions than we can using experimental methods and volunteer participants. For veterans who wear a lower limb prosthesis while carrying infants, toddlers, or other loads, this research will provide evidence to support prosthesis prescription practice that reduces undesirable compensatory responses to load carriage. Our objective is to help clinicians select among currently available solutions to enable veterans to achieve their life and work goals.

项目摘要（公共摘要） 自然下肢提供重要的生物力学功能，例如体重支撑、向前移动 行走过程中的推进和平衡控制。当下肢所承受的负荷发生变化时，下肢 肌肉激活做出相应反应，以实现生物力学功能的无缝延续。这些负载 可能会突然发生变化，例如携带婴儿、幼儿或其他负载（例如沉重的背包）时。为了 对于下肢截肢的人来说，承重负荷的突然变化可能会出现问题 因为它们会对步行表现产生负面影响。步行表现可能受到影响的原因之一是 大多数假肢的特性（例如刚度）是恒定的，不会改变以适应不同的情况 负载条件。另一个原因是最广泛使用的假脚没有电机、传感器、 或类似大脑的控制器，用于替代截肢的神经肌肉系统。无论 原因是，没有证据可以指导使用假肢行走的退伍军人的处方实践和经验 负载突然变化。 拟议的研究将使用实验和模型分析为 VA 临床医生提供指导 为经常携带婴儿、幼儿或其他孩子的下肢截肢退伍军人开出假肢处方 负载。我们提出的研究有两个具体目标： 具体目标 1：确定可改善退伍军人行走性能的假足 下肢截肢的人携带婴儿、幼儿或其他负载。我们建议进行人类受试者 在十五名膝盖以下截肢的人的帮助下进行实验。研究参与者将行走在 跑步机在无附加负载和使用加重包（13.6 千克或约 30 磅）的四种附加负载条件下 模拟婴儿、幼儿或其他负载。这四种情况包括背包绑在他们的前面、后面、 并用手臂携带完整肢体侧和假肢侧。每位参赛者将穿着平常的衣服 假脚，这只脚带有脚跟加固楔，相同的假脚，但一类刚度 更高，一种新上市的双龙骨假脚，用于负重情况，以及动力踝足 假肢。这些实验的结果将帮助 VA 临床医生为患者指定最佳假体 下肢截肢的退伍军人经常携带婴儿、幼儿或其他物品。 具体目标 2：确定肌肉对特定生物力学量的敏感性 响应不同的刚度和负载条件。我们建议使用先进的建模和 模拟分析以确定足部僵硬如何影响个体肌肉对特定肌肉的贡献 生物力学量，包括体重支撑、向前推进、平衡控制、能量 支出，以及目标 1 中检查的不同负载条件下的联合负载。我们将进一步执行 通过增加体重增量进行探索性分析，以发现肌肉对 生物力学量。我们预计这些结果将为这些关系提供重要的见解 因为通过我们的模型，我们可以探索比使用实验条件更广泛的条件 方法和志愿者参与者。 对于在携带婴儿、幼儿或其他负载时佩戴下肢假肢的退伍军人来说，这项研究将 提供证据支持假肢处方实践，减少不良代偿反应 装载车厢。我们的目标是帮助临床医生选择当前可用的解决方案，以使退伍军人能够 实现他们的生活和工作目标。