The Mechanism and Function of Lumbosacral Orthoses

描述（由申请人提供）：本申请通过检验四个假设，探索腰骶矫形器（LSO）在治疗腰痛（LBP）中的新机制和功能。这些假设是基于LSO增强脊柱稳定性的原理，之前在此背景下尚未考虑过。LSO为腰椎提供了额外的稳定性，因此，LBP患者将（i）与“无LSO”条件相比，当佩戴LSO时表现出较少的躯干拮抗肌共同收缩，（ii）与“无LSO”条件相比，当佩戴LSO时，以较少数量的肌肉和较长的潜伏期对突然的躯干负荷作出反应，（iii）与没有LSO的行走相比，当佩戴LSO时以更接近正常模式的步态行走，以及（iv）与“没有LSO”的情况相比，当佩戴LSO时在腰椎中表现出增强的本体感觉。将从耶鲁脊柱服务诊所招募20名LBP受试者（实验组）和20名对照LBP受试者，以检验每个假设。实验组受试者将佩戴LSO 4-6周。所有受试者将每两周在3个单独的实验中接受一次有无LSO的测试，以解决每个假设。这些实验将包括（1）EMG实验，以解决假设（i）和（ii），（2）步态实验，以解决假设（iii），和（3）本体感觉实验，以解决假设（iv）。 新的研究进展将使我们能够克服一些方法和概念上的困难，使拟议的研究现在可行。因此，以下特征的应用将使拟议的研究与过去的研究区分开来：（i）脊柱稳定性的概念和量化，（ii）调整以检测EMG活动中非常小的LSO效应的实验设计，（iii）用于使LBP患者的EMG数据标准化的新颖的次最大用力程序，所述LBP患者不愿意或不能施加最大努力，和（iv）长期（4-6周）研究，这可能是适应LSO所必需的。这些研究的结果可用于制定合理的指导方针，处方的LSO以及改进其设计。此外，从拟议的研究产生的数据也将结转到推进我们的机制和人体工程学腰部支撑的功能的理解。

DESCRIPTION (provided by applicant): New mechanisms and function of lumbosacral orthoses (LSOs) in the management of low back pain (LBP) are explored in this application by testing four hypotheses. These hypotheses are based on the rationale of LSO-enhanced spine stability, which has not been considered in this context before. The LSO provides additional stability to the lumbar spine and, therefore, patients with LBP will (i) exhibit less trunk antagonistic muscle co-contraction when wearing the LSO as compared to the "No LSO" condition, (ii) respond with a smaller number of muscles and longer latency to sudden trunk loading when wearing the LSO as compared to the "No LSO" condition, (iii) walk with gait closer resembling a normal pattern when wearing the LSO as compared to walking without the LSO, and (iv) exhibit enhanced proprioception in the lumbar spine when wearing the LSO as compared to the "No LSO" condition. Twenty LBP subjects for the experimental group and 20 control LBP subjects will be recruited from the Yale Spine Service clinics to test each hypothesis. The subjects in the experimental group will wear the LSO for 4-6 weeks. All subjects will be tested every two weeks with and without the LSO in 3 separate experiments to address each hypothesis. These experiments will consist of (1) the EMG Experiment to address hypotheses (i) and (ii), (2) the Gait Experiment to address hypothesis (iii), and (3) the Proprioception Experiment to address hypothesis (iv). New research developments will allow us to overcome several methodological and conceptual difficulties to make the proposed research now feasible. Therefore, the application of the following features will distinguish the proposed research from past studies: (i) the concept and quantification of spine stability, (ii) an experimental design tuned to detect very small LSO effects in EMG activity, (iii) a novel, submaximal exertion procedure for normalizing EMG data for patients with LBP, who are reluctant or unable to exert maximum effort, and (iv) a long-term (4-6 weeks) study, which may be necessary for acclimatization to the LSO. The results from these studies could be used in formulating rational guidelines for the prescription of LSOs as well as for improving their designs. In addition, data generated from the proposed research will also carry-over into advancing our understanding of the mechanisms and function of ergonomic lumbar supports.