Patient-Preferred Prosthetic Ankle-Foot Alignment for Ramps and Level-Ground Walking.
Patient-Preferred Prosthetic Ankle-Foot Alignment for Ramps and Level-Ground Walking.
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DOI：
10.1109/tnsre.2020.3033711
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Hargrove LJ
中科院分区：
文献类型：
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作者：
Shepherd MK;Simon AM;Zisk J;Hargrove LJ
患者对下肢假体行为的偏好非正式地指导临床决策，并且对于调整新的机器人假体可能变得越来越重要。然而，量化偏好的过程仍在发展中，偏好的优点和缺点还没有得到充分的理解。本研究旨在描述患者在平地行走时对线偏好的可靠性（一致性），并确定患者在10°坡道上升和下降时的首选踝关节角度，这对机器人假体的设计和控制有影响。7名经胫骨截肢的受试者在平地上行走，并在能够在背屈和跖屈中进行无重量重新定位的半主动假体踝关节上上升和下降10°坡道。首选踝关节角度测量与自适应强迫选择的心理物理学范式，其中受试者走在一个随机的静态踝关节角度，并报告他们是否会喜欢踝关节背屈或跖屈。受试者在平地行走时对对齐有可靠的偏好，与偏好的偏差为1.5°，导致84%的应答率倾向于朝着偏好的方向变化。相对于水平行走，受试者在坡道上升期间偏好背屈7.8°（SD：4.8°），在坡道下降期间偏好跖屈5.3°（SD：3.8°）。由于踝关节角度更好地匹配斜坡角度，关节窝压力和胫骨进展（胫骨倾斜）都更接近水平行走时的情况。这些发现提供了能够根据患者偏好适应斜坡的假肢踝关节的基线行为，并提供了强有力的证据表明，经胫骨截肢的人可以很好地感知踝关节对齐。
Patient preference of lower limb prosthesis behavior informally guides clinical decision making, and may become increasingly important for tuning new robotic prostheses. However, the processes for quantifying preference are still being developed, and the strengths and weaknesses of preference are not adequately understood. The present study sought to characterize the reliability (consistency) of patient preference of alignment during level-ground walking, and determine the patient-preferred ankle angle for ascent and descent of a 10° ramp, with implications for the design and control of robotic prostheses. Seven subjects with transtibial amputation walked over level ground, and ascended and descended a 10° ramp on a semi-active prosthetic ankle capable of unweighted repositioning in dorsiflexion and plantarflexion. Preferred ankle angle was measured with an adaptive forced-choice psychophysics paradigm, in which subjects walked on a randomized static ankle angle and reported whether they would prefer the ankle to be dorsiflexed or plantarflexed. Subjects had reliable preferences for alignment during level-ground walking, with deviations of 1.5° from preference resulting in an 84% response rate preferring changes toward the preference. Relative to level walking, subjects preferred 7.8° (SD: 4.8°) of dorsiflexion during ramp ascent, and 5.3° (SD: 3.8°) plantarflexion during ramp descent. As the ankle angle better matched the ramp angle, socket pressures and tibial progression (shank pitch) both more closely mirrored those during level walking. These findings provide baseline behaviors for prosthetic ankles capable of adapting to slopes based on patient preference, and provide strong evidence that people with transtibial amputation can finely perceive ankle alignment.