A Quantitative Analysis of Transfemoral Prosthetic Alignment

描述（由申请人提供）： 项目摘要/摘要假肢对线是下肢截肢者成功康复的一个重要方面，也是假肢是否能恢复功能、最大限度地减少步态偏差以及使用者是否舒适的决定性因素。修复师接受培训，在调整假肢时遵循迭代程序，这依赖于临床经验和患者反馈。修复师不断地修改假体对线，直到他们满意，病人表现出很少的步态偏差和舒适。然而，这一过程的可重复性很差，几乎没有科学依据。为了改善经股动脉对线的过程，并促进实践的客观基础，研究人员和临床医生必须首先获得更好地了解假体对线的变化和截肢者的生物力学反应之间的关系。对于经股截肢者来说，由于他们不能直接控制他们的假肢膝关节，所以肢体的股骨不稳定是一个主要的问题。因此，经股截肢者依靠臀部的肌肉策略来控制膝关节屈曲和伸展。假肢未对准的实际后果是，它可能需要截肢者产生过多的髋关节力矩来控制他们的膝关节，导致行走期间代谢能量消耗增加和疲劳。不正确的对准也可能导致步态不对称、假肢部件的性能差以及接受腔和残肢之间的不期望的压力，从而引起不适和压疮。本研究的目的是评估单侧经股截肢患者的步态生物力学如何随着矢状面对线的系统性变化而改变。在直线水平行走过程中，将研究假肢膝关节的线性平移和假肢足的旋转。为了测量经股截肢者对矢状面对齐变化的反应，我们将使用定量步态分析收集运动学和动力学数据。我们还将获得臀部肌肉组织的EMG数据，intrasocket接触压力和能量消耗测量。这项拟议的工作将表征假体错位和经股截肢者步态的功能反应之间的关系，包括生物力学不对称性，增加的能量消耗，和残肢疼痛。这项研究的结果将提供一个全面的了解如何经股截肢者控制他们的假体膝关节，并可能建立一个更系统的方法，临床假体对齐的过程。 公共卫生相关性： 项目叙述这项工作是直接适用于退伍军人事务部的病人护理使命，因为结果可能会改善步态和下肢截肢者的生活质量。由于接受腔配合、假体对线和部件性能方面的缺陷，经股截肢患者的步态不如健全人。这项拟议的工作将表征假肢错位和适应之间的关系，在经股截肢步态，包括步态不对称，动力学效率低下，增加能量消耗，和残肢疼痛。通过更好地了解假体对线如何影响经股截肢者的行走性能，本研究将建立标准，以更好地量化与对线相关的结果。此外，彻底了解经股截肢者如何控制他们的假肢膝关节可能对康复治疗有影响，并为改进假肢膝关节设计提供见解。

DESCRIPTION (provided by applicant): Project Summary/Abstract Prosthetic alignment is an important aspect in the successful rehabilitation of lower-limb amputees and is a deciding factor in whether the prosthetic limb will restore function, minimize gait deviations, and be comfortable for the user. Prosthetists are trained to follow an iterative procedure when aligning a prosthetic limb that relies on clinical experience and patient feedback. The prosthetist continually modifies prosthetic alignment until they are satisfied that the patient exhibits few gait deviations and is comfortable. However, this process suffers from poor repeatability and little scientific justification. In order to improve the process of transfemoral alignment and promote an objective basis for practice, researchers and clinicians must first acquire a better understanding of the relationship between variations in prosthetic alignment and the biomechanical response of the amputee. Sagittal instability of the limb is a primary concern for transfemoral amputees because they do not have direct control of their prosthetic knee joint. As a result, transfemoral amputees rely on muscle strategies at the hip to control knee flexion and extension. A practical consequence of prosthetic misalignment is that it may require the amputee to generate excessive hip moments to control their knee joint, resulting in increased metabolic energy expenditure and fatigue during walking. Improper alignment may also contribute to gait asymmetries, poor performance of prosthetic components, and undesirable pressure between the socket and residual limb, giving rise to discomfort and pressure sores. The purpose of this study is to evaluate how gait biomechanics of persons with unilateral, transfemoral amputations are altered in response to systematic changes in sagittal- plane alignment. Both linear translations of the prosthetic knee and rotations of the prosthetic foot will be investigated during straight, level walking. To measure the response of transfemoral amputees to variations in sagittal-plane alignment, we will collect kinematic and kinetic data using quantitative gait analysis. We will also acquire EMG data of hip musculature, intrasocket contact pressure, and energy expenditure measurements. This proposed work will characterize the relationship between prosthetic misalignment and the functional response of transfemoral amputee gait, including biomechanical asymmetries, increased energy expenditure, and residual limb pain. The results of this study will provide a thorough understanding of how transfemoral amputees control their prosthetic knee joint and may establish a more systematic approach to the process of clinical prosthetic alignment. PUBLIC HEALTH RELEVANCE: Project Narrative This work is directly applicable to the VA's Patient Care Mission because the results may improve the gait and quality of life of persons with lower-extremity amputations. The gait of persons with transfemoral amputations is inferior to that of able-bodied individuals due to deficiencies in socket fit, prosthetic alignment, and performance of components. This proposed work will characterize the relationship between prosthetic misalignment and adaptations in transfemoral amputee gait, including gait asymmetries, kinetic inefficiencies, increased energy expenditure, and residual limb pain. With a better understanding of how prosthetic alignment affects the walking performance of transfemoral amputees, this study will establish criteria to better quantify outcomes related to alignment. Furthermore, a thorough understanding of how transfemoral amputees control their prosthetic knee may have implications for rehabilitation therapies and provide insight for improved prosthetic knee designs.