Sensory-Motor Mechanisms Underlying Fall Risk in Transtibial Amputees

说明： 马修·梅杰博士的这项为期五年的职业发展奖(CDA-2)的拟议研究和培训将通过开展旨在减少跌倒并提高接受胫骨截肢(TTA)的老年退伍军人的生活质量的研究，为实现退伍军人管理局的使命和愿景做出贡献]，同时增强梅杰博士的技能，作为退伍军人管理局系统的独立研究员，指导康复科学的动态研究计划。以前的研究表明，与身体健全的年龄匹配的对照组相比，截肢老年人跌倒的风险大大增加，对他们的平衡信心降低，这两者都导致他们的行动能力和日常活动受限。由于直立平衡对安全活动至关重要，跌倒发生率增加的一个重要后果是与跌倒相关的伤害风险增加，这可能导致丧失独立性和早期死亡。由于缺乏关于这一主题的全面对照研究，在这一人群中，姿势控制变量与跌倒风险之间的关系仍然知之甚少，这严重阻碍了解决退伍军人[TTA]这一重要关切的进展。因此，拟议的研究活动将涉及一系列对照实验，以深入了解患有[TTA]的老年退伍军人直立平衡和跌倒风险的感觉-运动机制。这两个具体目标是：1)识别与[TTA]老年人之间的直立平衡相关的区分生物力学和临床因素，[TTA]被归类为[频繁跌倒和对照]；2)评估[TTA]老年人在站立和行走时受到意外扰动时所采用的运动控制策略。这些研究活动将在退伍军人管理局杰西·布朗医学中心运动分析研究实验室进行，指导人员是退伍军人研究中心康复和假肢研究的资深健康科学家Steven Gard博士。这项研究的信息将导致识别与FL风险相关的感觉-运动变量，这些变量可以通过有针对性的干预和开发与临床相关的跌倒预测模型来修改。梅杰博士的职业目标是成为退伍军人康复研究和发展局的一名高技能独立调查员。由于之前的研究和培训，他已经发展了与研究人类运动的生物力学相关的坚实的技能基础，特别是关注腿部假肢使用者的步态。梅杰博士提议开展多样化的培训活动，通过完善截肢者临床护理和运动控制理论方面的技能，来补充他在生物力学方面的教育。他的目标是发展一个富有成效的退伍军人研究生涯，旨在改善患有神经肌肉和肌肉骨骼侮辱的退伍军人的功能平衡和灵活性。他的培训计划包括在假肢临床教育、临床和翻译科学、项目管理、团队领导和授予写作技能方面的正规教育，以发展他作为独立退伍军人管理局科学家和有效领导者的能力。梅杰博士组建了一支资质良好的导师团队，他们将以定向阅读的形式就拟议项目的各个方面提供专家指导，最重要的是，接触退伍军人管理局的医疗系统，以便他可以制定一项对VHA患者护理任务敏感的研究计划。这项研究的结果将有助于追求未来的研究计划，以探索用于改善姿势控制的治疗干预设计，可整合到退伍军人护理系统中，开发临床诊断工具以准确评估患有[TTA]的老年退伍军人的跌倒风险，向退伍军人管理局提供当前假体的处方指南，并设计未来可增强功能平衡的假体设备。重要的是，这些结果将为提交两个退伍军人管理局优秀奖奠定基础，这两个奖项将有助于将梅杰博士转变为致力于履行VHA患者护理使命和愿景的独立调查员。

DESCRIPTION: The proposed research and training for this five-year Career Development Award (CDA-2) of Dr. Matthew Major, PhD, will contribute to the realization of the VA mission and vision by conducting studies that aim to reduce falls and improve the quality of life of older veterans with transtibial amputation (TTA)] while enhancing Dr. Major's skills to direct a dynamic research program of rehabilitation science as an independent investigator in the VA system. Previous studies have demonstrated that older persons with lower limb amputation are at a substantially increased risk of falling as compared to able-bodied age-matched controls and have reduced confidence in their balance, both contributing to their restricted mobility and daily activity. As upright balance is vital to safe mobility, an important consequence of elevated fall incidence is an increased risk of fall-related injuries that may lead to lost independence and early mortality. Due to the dearth of comprehensive controlled studies on this topic, the relationships between variables of postural control and fall risk in this population remain poorly understand and this has significantly hampered progress towards addressing this important concern for veterans with [TTA]. Therefore, the proposed research activities will involve a series of controlled experiments to develop much-needed insight into the sensory-motor mechanisms of upright balance and fall risk in older veterans with [TTA]. The two specific aims are: 1) identify discriminating biomechanical and clinical factors related to upright balance between older adults with [TTA] classified as [frequent fallers and controls], and 2) evaluate the motor control strategies employed by older adults with [TTA] when subjected to an unexpected perturbation during standing and walking. These research activities will be performed in the Jesse Brown VA Medical Center Motion Analysis Research Laboratory under the guidance of Dr. Steven Gard, an experienced VA Research Health Scientist of rehabilitation and prosthetics research. Information from this study will lead to the identification of sensory-motor variables related to fll risk that may be modified through targeted interventions and development of a clinically-relevant predictive model of falls. Dr. Major's career objective is to become a highly skilled independent investigator within the VA Rehabilitation Research and Development Service. Resulting from previous research and training, he has developed a solid foundation of skills related to investigating the biomechanics of human movement with specific focus on gait of lower limb prosthesis users. Dr. Major is proposing diverse training activities that will compliment his education in biomechanics by refining skills in amputee clinical care and motor control theory. His goal is to develop a productive VA research career aimed at improving functional balance and mobility of veterans with neuromuscular and musculoskeletal insult. His training plan includes formal education in prosthetics clinical education, clinical and translational sciences, project management, team leadership, and grant writing skills to develop his abilities as an independent VA scientist and effective leader. Dr. Major has assembled a well-qualified team of mentors who will provide expert guidance on various aspects of the proposed project in the form of directed readings and, most critically, exposure to the VA healthcare system such that he may develop a research program that is sensitive to the VHA patient care mission. The results of this research will facilitate pursuit of future research initiatives to explore design of theraputic interventions for improving postural control that may be integrated into the VA system of care, development of clinical diagnostic tools to accurately assess fall risk in older veterans with [TTA], inform VA prescription guidelines of current prostheses, and design future prosthetic devices that enhance functional balance. Importantly, these results will provide the basis for the submission of two VA Merit Awards that will be instrumental in transitioning Dr. Major to the role of an independent investigator working to fulfill the VHA patient care mission and vision.