Optimization of Prosthetic Foot and Ankle Stiffness for Standing and Walking

站立和行走时假足和踝关节刚度的优化

• 批准号: 10261529
• 负责人: Steven A. Gard
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10261529
• 关键词: Affect; Amputation; Amputees; Anatomy; Ankle; Articular Range of Motion; Biomechanics; Characteristics; Data; Development; Energy Metabolism; Equation; Equilibrium; Exertion; Gait; Individual; Intervention; Investigation; Joints; Kinetics; Knee; Leg; Limb Prosthesis; Lower Extremity; Manufacturer Name; Measures; Mechanics; Metabolic; Mission; Modeling; Motion; Normal Range; Patient Care; Patients; Perception; Performance; Persons; Phase; Prosthesis; Quality of life; Questionnaires; Radial; Recommendation; Reporting; Research Subjects; Risk; Series; Shapes; Speed; Testing; Validation; Veterans Health Administration; Walking; Water; ankle joint; ankle prosthesis; balance recovery; cost; experimental study; falls; foot; improved; joint stiffness; kinematics; novel; pressure; prospective; prosthesis wearer; prosthetic foot; public health relevance; research study; tool; walking speed

 DESCRIPTION: Persons who walk with lower-limb prostheses are generally less efficient ambulators than able-bodied individuals (Waters et al., 1976) and their stability is compromised, attributable in part t deficiencies in the function of their prostheses (Gard & Fatone, 2004). Anatomical ankle joint stiffness in able-bodied persons adapts with walking speed (Hansen et al., 2004) and for standing (Hansen & Wang, 2010). Fitting lower-limb amputees with prosthetic foot and ankle mechanisms that attempt to replicate corresponding anatomical functions is desirable (Hansen et al., 2004a,b, 2007, 2010). We previously demonstrated that prosthetic ankle joints improve walking performance in persons with transtibial (below-knee) amputation (Su et al., 2008, 2009, 2010). In that study, research subjects clearly preferred walking with the prosthetic ankle components, but several indicated that they felt unstable during standing (Su et al., 2010). Subsequent analyses of those data indicated that the addition of a compliant prosthetic ankle unit significantly reduced the radius of the ankle-foot roll-over shape (Gard et al., 2011), which can adversely affect standing stability and gait performance (Gard & Childress, 2001; Klodd et al., 2010a,b). The purpose of this investigation is to determine how systematically varying the prosthetic foot keel stiffness and prosthetic ankle joint stiffness affects standing and walking in persons with unilateral, transtibial amputations. The specific aims for this study are: 1. To determine how different combinations of prosthetic foot and ankle stiffness affect gait biomechanics of unilateral, transtibial prosthesis users. Kinematic, kinetic and energy expenditure data will be collected as subjects walk at different speeds and with different combinations of prosthetic foot and ankle stiffness. 2. To determine how different combinations of prosthetic foot and ankle stiffness affect standing stability of unilateral, transtibial prostheis users. Standing balance of subjects will be evaluated using a series of tests that measure balance and recovery stability as balance is perturbed. Subjects will also be administered questionnaires to document their perceptions of comfort, exertion and stability while using the different prosthetic foot-ankle configurations. Compliant foot-ankle mechanisms that allow for a normal range of ankle joint motion during walking are expected to increase gait performance, but decrease standing stability. Conversely, a rigid foot-ankle combination will likely maximize standing stability, but decrease gait performance. Determination of an optimal prosthetic foot and ankle stiffness combination will require a compromise between the apparent disparate objectives for these two activities. Increased understanding about how different prosthetic foot-ankle stiffness combinations affect standing and walking abilities will facilitate appropriate component selection by prosthetists, encourage development of prosthetic foot-ankle mechanisms with adaptable stiffness, and ultimately improve quality of life for prosthesis users.

 描述： 使用下肢假肢行走的人通常比身体健全的人行走效率较低（Waters et al., 1976），并且他们的稳定性受到损害，部分原因是假肢功能缺陷（Gard & Fatone, 2004）身体健全的人的解剖学踝关节僵硬会随着步行速度和站立而变化（Hansen et al., 2004） （Hansen & Wang，2010）。为下肢截肢者安装假足和踝关节机构，尝试复制相应的解剖功能是可取的（Hansen 等人，2004a，b，2007，2010）。改善小腿（膝盖以下）截肢者的步行表现（Su 等人，2008 年， 2009，2010）。在该研究中，研究对象显然更喜欢使用假肢踝关节组件行走，但一些人表示他们在站立时感觉不稳定（Su 等人，2010）。对这些数据的后续分析表明，添加顺应性踝关节组件。假肢踝关节装置显着减小了踝足翻滚形状的半径（Gard 等，2011），这会对站立稳定性和步态表现产生不利影响（Gard & Childress， 2001；Klodd 等人，2010a,b) 这项调查的目的是确定如何系统地改变假足龙骨刚度和假肢踝关节刚度对站立和行走的影响。 本研究的具体目的是： 1. 确定假肢足和踝关节硬度的不同组合如何影响单侧经胫骨假肢使用者的步态生物力学，并将收集作为受试者的运动、动力学和能量消耗数据。以不同的速度和不同的假脚和踝关节刚度组合行走 2. 确定不同的假脚和踝关节刚度组合如何影响站立。当平衡受到干扰时，将使用一系列测量平衡和恢复稳定性的测试来评估受试者的站立平衡的稳定性。不同的足踝假肢配置允许步行时踝关节进行正常范围的运动，预计会提高步态性能，但会降低离线时的站立稳定性。可能会最大限度地提高站立稳定性，但会降低步态性能 确定最佳的假肢足和踝关节刚度组合需要在这两种活动的明显不同目标之间进行折衷，进一步了解不同的假肢足踝刚度组合如何影响站立和行走能力。将有助于假肢专家选择适当的组件，鼓励开发具有适应性刚度的假肢足踝机构，并最终提高假肢使用者的生活质量。

项目成果

The Effect of Prosthetic Ankle Dorsiflexion Stiffness on Standing Balance and Gait Biomechanics in Individuals with Unilateral Transtibial Amputation.

假肢踝关节背屈刚度对单侧小腿截肢患者站立平衡和步态生物力学的影响。

• 发表时间: 2022-10-21
• 作者: Vaca, Miguel;Stine, Rebecca;Hammond 2nd, Paul;Cavanaugh, Michael;Major, Matthew J;Gard, Steven A
• 通讯作者: Gard, Steven A