Sensory-Motor Mechanisms Underlying Fall Risk in Transtibial Amputees

小腿截肢者跌倒风险背后的感觉运动机制

• 批准号: 10174728
• 负责人: Matthew J. Major
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2020-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10174728
• 关键词: Address; Affect; Age; Aging; Amputation; Amputees; Articular Range of Motion; Assessment tool; Award; Balance training; Behavior; Biomechanics; Characteristics; Clinical; Clinical Sciences; Controlled Study; Data; Detection; Development; Development Plans; Doctor of Philosophy; Education; Elderly; Equilibrium; Exhibits; Exposure to; Foundational Skills; Future; Gait; Gender; Goals; Grant; Guidelines; Health; Health Hazards; Healthcare Systems; High Prevalence; Human; Impairment; Incidence; Independent Living; Individual; Injury; Intervention; Investigation; Joints; K-Series Research Career Programs; Knee Prosthesis; Knowledge; Laboratory Research; Lead; Leadership; Limb structure; Link; Locomotion; Logistic Regressions; Lower Extremity; Matched Group; Medical center; Mentors; Mission; Modeling; Motion; Motor; Movement; Muscle; Musculoskeletal; Musculoskeletal Equilibrium; Nervous System control; Neuraxis; Outcome; Outcome Measure; Patient Care; Persons; Play; Population; Predictive Factor; Proprioception; Prosthesis; Prosthesis Design; Quality of life; Reading; Recovery; Regression Analysis; Rehabilitation therapy; Reporting; Research; Research Activity; Research Personnel; Research Project Grants; Research Training; Risk; Role; Scientist; Sensory; Series; Services; Solid; System; Techniques; Therapeutic Intervention; Training; Training Activity; Translational Research; Veterans; Vision; Walking; Writing; base; care systems; career; career development; clinical care; clinical development; clinical diagnostics; clinically relevant; control theory; design; experience; experimental study; fall risk; falls; fear of falling; improved; insight; limb amputation; mortality; motor control; muscle strength; neuromuscular; novel; predictive modeling; programs; prospective; prosthesis wearer; public health relevance; rehabilitation research; rehabilitation science; research and development; skills; somatosensory; synergism; therapy development; tool; treadmill

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.

描述： Matthew Major博士博士的这项为期五年职业发展奖（CDA-2）的拟议研究和培训将通过进行旨在减少跌倒并改善老年退伍军人生活质量（TTA）的退伍军人生活质量（TTA）的研究来帮助实现VA任务和愿景，同时提高了Majo博士的技能，使Major Dr. Dromice Indement Indextication System of Rehablitation Science of Rehabilitation Science a reaghitation Science a reaghitiation Science a reaghitiation Science a reaghitiation Science的技能。先前的研究表明，与健全的年龄匹配的对照相比，下肢截肢的老年人大大增加了下降的风险，并且降低了对平衡的信心，这既导致了他们的限制性流动性和日常活动。由于直立的平衡对于安全流动至关重要，因此跌倒发病率升高的重要结果是跌倒相关的伤害的风险增加，可能导致独立性失去独立性和早期死亡率。由于缺乏有关该主题的全面对照研究的缺乏，该人群的姿势控制变量与跌倒风险之间的关系仍然很糟糕，这对解决[TTA]的退伍军人的这一重要关注而极大地阻碍了[TTA]的这一重要关注。因此，拟议的研究活动将涉及一系列受控的实验，以发展急需的洞察力，以了解[TTA]的老年退伍军人的直立平衡和下降风险的感觉。这两个具体目的是：1）确定与[TTA]归类为[频繁的堕落者和控制者]的老年人之间的歧视生物力学和临床因素，以及2）评估[TTA]在站立和步行过程中进行意外的伴随时，评估[TTA]老年人使用[TTA]采用的运动控制策略。这些研究活动将在杰西·布朗·弗吉尼亚州医学中心运动研究实验室中在经验丰富的VA研究健康科学家史蒂文·加德（Steven Gard）的指导下进行。这项研究的信息将导致鉴定与FLL风险相关的感觉运动变量，这些变量可以通过靶向干预措施和临床上与临床相关的跌倒预测模型进行修改。 Major博士的职业目标是成为VA康复研究和开发服务局中高技能的独立研究者。由于先前的研究和培训，他为研究人类运动的生物力学而建立了坚实的技能基础，特别关注下肢假体使用者的步态。 Major博士正在提出各种各样的培训活动，这将通过完善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。他的目标是开发旨在提高退伍军人的功能平衡和流动性的富有成效的研究生涯，并具有神经肌肉和肌肉骨骼的侮辱。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，团队领导和授予写作技巧，以发展他作为独立VA科学家和有效领导者的能力。 Major博士召集了一个合格的导师团队，他们将以定向阅读的形式为拟议项目的各个方面提供专家指导，并最严重地接触VA Healthcare System，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，以探索治疗干预措施的设计，以改善姿势控制，这些干预措施可能会整合到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的跌落风险[TTA]，告知VA处方药，以使VA处方指南的当前专业人士和未来的设备提高了未来的功能。重要的是，这些结果将为提交两个VA功绩奖项的基础提供基础，这将有助于将Major Dr. Major Dr. Dr. Dr. Dr.

项目成果

Skill assessment in upper limb myoelectric prosthesis users: Validation of a clinically feasible method for characterising upper limb temporal and amplitude variability during the performance of functional tasks.

• DOI: 10.1016/j.medengphy.2017.03.010
• 发表时间: 2017-09
• 期刊: Medical engineering & physics
• 影响因子: 2.2
• 作者: S. Thies;L. Kenney;Mohammad Sobuh;A. Galpin;P. Kyberd;R. Stine;M. Major

Proactive Locomotor Adjustments Are Specific to Perturbation Uncertainty in Below-Knee Prosthesis Users.

• DOI: 10.1038/s41598-018-20207-5
• 发表时间: 2018-01-30
• 期刊: Scientific reports
• 影响因子: 4.6
• 作者: Major MJ;Serba CK;Chen X;Reimold N;Ndubuisi-Obi F;Gordon KE
• 通讯作者: Gordon KE

Do Upper Limb Loss and Prosthesis Use Affect Lower Limb Gait Dynamics?

• DOI: 10.1097/jpo.0000000000000333
• 发表时间: 2019-07-22
• 期刊: Journal of prosthetics and orthotics : JPO
• 作者: Armstrong K;Brinkmann JT;Stine R;Gard SA;Major MJ
• 通讯作者: Major MJ

Does Decreasing Below-Knee Prosthesis Pylon Longitudinal Stiffness Increase Prosthetic Limb Collision and Push-Off Work During Gait?

降低膝下假肢塔架的纵向刚度是否会增加步态期间假肢的碰撞和推离工作？

• DOI: 10.1123/jab.2019-0043
• 发表时间: 2019
• 期刊: Journal of applied biomechanics
• 影响因子: 1.4
• 作者: Major,MatthewJ;Zavaleta,JoséLuis;Gard,StevenA
• 通讯作者: Gard,StevenA

The feasibility and validity of a wearable sensor system to assess the stability of high-functioning lower-limb prosthesis users.

• DOI: 10.1097/jpo.0000000000000332
• 发表时间: 2020-08-11
• 期刊: Journal of prosthetics and orthotics : JPO
• 作者: Miller KT;Russell M;Jenks T;Surratt K;Poretti K;Eigenbrot SS;Akins JS;Major MJ
• 通讯作者: Major MJ