Sensory-Motor Mechanisms Underlying Fall Risk in Transtibial Amputees

描述： Matthew Major 博士的五年职业发展奖 (CDA-2) 拟议的研究和培训将有助于实现 VA 的使命和愿景，开展旨在减少跌倒和改善小腿截肢 (TTA) 老年退伍军人的生活质量的研究，同时增强 Major 博士作为 VA 系统的独立研究者指导动态康复科学研究计划的技能。先前的研究表明，与年龄匹配的身体健康对照者相比，下肢截肢的老年人跌倒的风险大大增加，并且对自己的平衡能力的信心降低，这都导致他们的活动能力和日常活动受到限制。由于直立平衡对于安全移动至关重要，因此跌倒发生率升高的一个重要后果是跌倒相关伤害的风险增加，这可能导致丧失独立性和过早死亡。由于缺乏关于该主题的全面对照研究，对该人群的姿势控制变量与跌倒风险之间的关系仍然知之甚少，这极大地阻碍了解决退伍军人[TTA]这一重要问题的进展。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]的老年退伍军人的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) 确定与分类为[经常跌倒和对照]的 [TTA] 老年人之间直立平衡相关的区别性生物力学和临床因素，2) 评估 [TTA] 老年人在站立和行走过程中遭受意外扰动时采用的运动控制策略。这些研究活动将在杰西·布朗退伍军人事务部医疗中心运动分析研究实验室进行，史蒂文·加德博士是一位经验丰富的退伍军人事务部康复和假肢研究健康科学家。这项研究的信息将有助于识别与跌倒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措施和开发临床相关的跌倒预测模型来修改。 Major 博士的职业目标是成为 VA 康复研究与开发服务部门的一名高技能独立调查员。通过之前的研究和培训，他在研究人体运动生物力学方面打下了坚实的技能基础，特别关注下肢假肢使用者的步态。梅杰博士提出了多样化的培训活动，通过提高截肢者临床护理和运动控制理论的技能来补充他在生物力学方面的教育。他的目标是发展富有成效的退伍军人事务部研究生涯，旨在改善遭受神经肌肉和肌肉骨骼损伤的退伍军人的功能平衡和活动能力。他的培训计划包括假肢临床教育、临床和转化科学、项目管理、团队领导和拨款写作技能方面的正规教育，以培养他作为独立 VA 科学家和有效领导者的能力。 Major 博士组建了一支高素质的导师团队，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 VA 医疗保健系统，以便他可以开发一个对 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开展未来的研究计划，探索治疗干预措施的设计，以改善姿势控制，并可将其纳入 VA 护理系统中，开发临床诊断工具以准确评估老年退伍军人 [TTA] 的跌倒风险，告知 VA 当前假肢的处方指南，并设计未来增强功能平衡的假肢装置。重要的是，这些结果将为提交两项 VA 优异奖奠定基础，这将有助于将 Major 博士转变为独立研究者，致力于实现 VHA 患者护理使命和愿景。

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.