A Quantitative Analysis of Transfemoral Prosthetic Alignment

经股假肢对准的定量分析

• 批准号: 8856548
• 负责人: Steven A. Gard
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8856548
• 关键词: Affect; Amputation; Amputees; Area; Biomechanics; Clinical; Data; Decubitus ulcer; Educational process of instructing; Energy Metabolism; Equation; Exhibits; Fatigue; Feedback; Flexor; Gait; Health Personnel; Hip Joint; Hip region structure; Hour; Individual; Inferior; Judgment; Kinetics; Knee; Knee joint; Limb structure; Lower Extremity; Measurement; Measures; Metabolic; Methods; Mission; Muscle; Muscle Fatigue; Outcome; Pain; Patient Care; Patients; Performance; Persons; Procedures; Process; Prosthesis; Quality of life; Rehabilitation Outcome; Rehabilitation therapy; Relative (related person); Reporting; Research; Research Personnel; Residual state; Rotation; Techniques; Time; Training; Translations; Variant; Visual; Walking; Work; abstracting; base; cost; design; experience; foot; functional restoration; gait examination; improved; insight; kinematics; pressure; prosthetic alignment; response; theories

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.

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。

项目成果

The biomechanical response of persons with transfemoral amputation to variations in prosthetic knee alignment during level walking.

• DOI: 10.1682/jrrd.2014.12.0311
• 发表时间: 2016-01-01
• 期刊: Journal of rehabilitation research and development
• 作者: Koehler-McNicholas, Sara R;Lipschutz, Robert D;Gard, Steven A
• 通讯作者: Gard, Steven A