Improving Dynamic Walking Stability in Traumatic Amputees

提高创伤性截肢者的动态行走稳定性

• 批准号: 8431350
• 负责人: Jonathan B Dingwell
• 金额: $ 23.48万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-15 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8431350
• 关键词: Accidental Injury; Address; Adopted; Affect; Age; Amputation; Amputees; Balance training; Behavior; Biomechanics; Cessation of life; Clinical; Crowding; Data; Distal; Elderly; Engineering; Environment; Equilibrium; Event; Evidence based treatment; Exhibits; Fall prevention; Feedback; Foundations; Gait; Goals; Health; Healthcare; Healthy People 2010; Height; Hip Fractures; Human; Impairment; Injury; Intervention; Knowledge; Laboratories; Lateral; Lead; Leg; Lower Extremity; Measures; Mechanics; Modeling; Motor; Movement; Muscle; Patient Monitoring; Patient Participation; Patients; Performance; Physical activity; Poaceae; Population; Populations at Risk; Preventive Intervention; Prosthesis; Protocols documentation; Public Health; Randomized; Recovery; Rehabilitation therapy; Relative (related person); Resources; Sensory; Speed; Stroke; Surface; Testing; Therapeutic Intervention; Time; Training; Training Programs; Translating; Traumatic Amputation; Traumatic Brain Injury; Vision; Visual; Walking; Weight; Work; active control; base; clinical practice; compare effectiveness; conventional therapy; cost; design; experience; fall risk; falls; fear of falling; improved; injury prevention; kinematics; limb amputation; neuromuscular; novel; older patient; patient population; response; somatosensory; standard care; therapy design; treatment strategy; treatment trial; virtual; virtual reality; visual feedback

DESCRIPTION (provided by applicant): Walking is an extremely important and common daily activity. Many locomotor impairments increase people's risk of falling. The total costs of all fall-related injuries may reach $43.8 billion by 2020. As many as 60% of patients with lower extremity amputation fall each year. Falls are especially problematic for young patients with traumatic amputation, who fall slightly more than older patients. Most people fall while they are walking. Also, very limited scientific evidence exists to guide design of interventions to improve walking function in patients with amputation. Thus, there is a clear need to better understand how patients with lower limb amputation respond to ecologically relevant perturbations, to identify the biomechanical and neuromuscular strategies these patients use to recover balance after being perturbed, and to develop effective evidence based treatment strategies to help these patients improve their walking stability. Our lab has developed novel engineering approaches to measure walking stability that directly quantify how humans respond to small perturbations. The primary goal of this study is to develop interventions to help prevent falls. This requires intervening before the fall itself occurs. While falls themselves are very elusive events, significant stumbles are very common. In the elderly, stumbling or tripping causes more than half of all falls. Therefore, stumbling is one of the primary precursors to falling. Stumbles often lead to fear of falling, excessive caution, and decreased physical activity. Surprisingly, however, no study has quantified stumbling responses in patients with lower limb amputation. For this project, we will first determine how patients with trans-tibial amputation respond to small, continuous pseudo-random visual or mechanical perturbations, similar to those they might experience walking outdoors over uneven terrain or in crowded public places. We will also directly test the common clinical assumption that these patients rely more heavily on vision because of their loss of distal somatosensory feedback. Second, we will determine how patients with trans-tibial amputation respond to large discrete mechanical perturbations during walking, such as they might experience when tripping over a curb or stepping in a pothole. From these data, we will identify specific biomechanical and neuromuscular strategies amputees use to recover balance after they stumble. Finally, we will determine if targeted virtual reality based gait training is more successful than conventional therapy for improving walking stability in patients with trans-tibial amputation. A fully immersive virtual environment will allow us to apply highly controlled and ecologically relevant perturbations, which we anticipate will generalize more readily to real world walking. This study will apply novel experimental and rigorous analytical approaches to significantly improve our understanding of how patients with amputation respond to perturbations. We will translate this knowledge into clinical practice by developing rehabilitation interventions based on our scientific findings. Finally, this work will provide a scientific basis for developing better interventions to improve walking function in populations with other walking related impairments.

描述(申请人提供)：步行是一项极其重要和常见的日常活动。许多运动障碍会增加人们跌倒的风险。到2020年，所有与跌倒相关的伤害的总成本可能达到438亿美元。每年有多达60%的下肢截肢患者跌倒。对于创伤性截肢的年轻患者来说，跌倒尤其严重，他们的跌倒比年长的患者略多。大多数人在走路时摔倒。此外，指导截肢患者改善步行功能的干预措施设计的科学证据也非常有限。因此，显然有必要更好地了解截肢患者对生态相关干扰的反应，确定这些患者在受到干扰后恢复平衡所使用的生物力学和神经肌肉策略，并开发有效的循证治疗策略来帮助这些患者改善他们的行走稳定性。我们的实验室开发了新的工程方法来测量行走稳定性，直接量化人类对微小扰动的反应。这项研究的主要目标是开发有助于预防跌倒的干预措施。这需要在跌落本身发生之前进行干预。虽然跌倒本身是非常难以捉摸的事件，但重大绊倒是非常常见的。在老年人中，跌倒或绊倒导致了一半以上的跌倒。因此，绊倒是跌倒的主要前兆之一。绊倒往往会导致害怕摔倒、过度谨慎和体力活动减少。然而，令人惊讶的是，还没有研究量化下肢截肢患者的跌倒反应。在这个项目中，我们将首先确定胫骨截肢患者对微小的、连续的伪随机视觉或机械扰动的反应，类似于他们可能在户外崎岖地形或拥挤的公共场所行走的情况。我们还将直接测试常见的临床假设，即这些患者更严重地依赖视觉，因为他们失去了远端躯体感觉反馈。其次，我们将确定胫骨截肢患者在行走过程中对大的离散机械扰动的反应，例如他们在绊倒路缘或踩到坑洞时可能会经历的情况。从这些数据中，我们将确定截肢者在跌倒后恢复平衡所使用的特定生物力学和神经肌肉策略。最后，我们将确定基于虚拟现实的定向步态训练在改善胫骨截肢患者行走稳定性方面是否比传统疗法更成功。完全身临其境的虚拟环境将允许我们应用高度受控和生态相关的扰动，我们预计这将更容易推广到真实世界的行走。这项研究将应用新的实验和严格的分析方法来显著提高我们对截肢患者如何对干扰做出反应的理解。我们将根据我们的科学发现，通过开发康复干预措施，将这些知识转化为临床实践。最后，这项工作将为开发更好的干预措施来改善其他步行相关障碍人群的步行功能提供科学依据。