Fall risk and prosthetic influence on gait biomechanics in upper limb amputees

跌倒风险和假肢对上肢截肢者步态生物力学的影响

• 批准号: 9000586
• 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: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9000586
• 关键词: Affect; Amputees; Attention; Bilateral; Biomechanics; Characteristics; Chest; Clinical; Data; Development; Devices; Elbow; Elderly; Ensure; Equilibrium; Etiology; Evaluation; Exhibits; Gait; Goals; Hand; Health Hazards; Incidence; Individual; Injury; Internet; Investigation; Lateral; Lead; Light; Limb Prosthesis; Limb structure; Literature; Measures; Metabolic; Motion; Movement; Patient Self-Report; Patients; Pelvis; Performance; Persons; Play; Population; Prevalence; Property; Prosthesis; Prosthesis Design; Psychometrics; Quality of life; Questionnaires; Recording of previous events; Recovery; Regression Analysis; Research; Role; Safety; Statistical Methods; Technology; Telephone Interviews; Training; Upper Extremity; Upper Extremity Fracture; Veterans; Walking; Wit; Wrist; arm; cost; fall risk; falls; grasp; improved; insight; predictive modeling; prosthesis wearer; public health relevance; rehabilitation strategy; simulation; sound; wrist fracture

DESCRIPTION (provided by applicant): Natural arm dynamics play a critical role during ambulation, specifically for ensuring efficient and stable walking and avoiding a fall when faced with sudden perturbation. Accordingly, restriction of arm swing during able-bodied gait has been observed to increase metabolic cost, impair lateral stability, and interrupt natural walking dynamics. Importantly, arresting a fall wit outstretched arms is a common strategy for avoiding bodily injury, with falls causing 97% of upper limb fractures in older adults and 76% of wrist fractures resulting from direct impact to the hand. Consequently, the importance of natural and responsive arm dynamics for efficient and safe ambulation may have significant implications for persons with upper limb loss when not using a prosthesis or only wearing a prosthesis for specific daily activities. Whereas the vast majority of research on upper limb prostheses users has focused on functional use (e.g., reaching and grasping), little attention has been paid to their gait and standing balance characteristics. Consequently, the impact of upper limb loss on walking and standing, particularly in relation to the ability to avoid a fall, remains poorly understood. In light of the importance of arms in maintaining upright balance, we hypothesize that individuals with upper limb loss will exhibit altered ambulatory characteristics compared to able-bodied persons that will create instability and increase their risk of falls and fall-related injuries. Anecdotal evidece from clinicians has supported this hypothesis. Therefore, the primary objective of this project is to explore the impact of upper limb loss on the risk of falls and characteristics of gait and standing balance. To achieve this objective, qualitative and biomechanical data will be collected on individuals with upper limb loss. Qualitative data on etiology, mobility and balance confidence, and fall history will be collected with a questionnaire on individuals with unilateral r bilateral upper limb loss at or proximal to the level of the wrist. The questionnaire will be administered via the internet, telephone interviews, and hardcopy format. Biomechanical data of steady-state gait and standing balance will be collected on upper limb prosthesis users with unilateral limb loss above and below the elbow while: 1) using their current prosthesis, 2) not using a prosthesis, and 3) using an experimental mock (i.e., nonfunctional) prosthesis that matches the inertial properties of the sound limb. Observed biomechanical data will include those previously shown to be associated with fall risk and instability in elderly and other pathological populations prone to unsteadiness. Within-group differences will be analyzed through appropriate repeated measures statistical methods and regression analysis will be applied to develop a predictive model for falls in individuals with upper limb loss. As there is a dearth of information available on the impact of upper limb loss on falls and characteristics of walking and standing, results from this project will provide much-needed insight into this topic and quantify an undocumented health hazard to this population. Subsequent studies will then focus on identifying the underlying mechanisms of instability in upper limb prosthesis users. The long term goal is to develop effective rehabilitation strategies and enhanced technology (e.g., improved prosthesis designs) that facilitate efficient and safe movement and lead to reduced falls, increased daily participation, and an improved quality of life.

描述（由申请人提供）： 自然手臂动力学在步行过程中起着关键作用，特别是在面对突然的扰动时，确保有效和稳定的步行并避免跌倒。因此，已经观察到在健全步态期间限制手臂摆动会增加代谢成本、损害侧向稳定性并中断自然行走动力学。重要的是，用伸出的手臂阻止跌倒是避免身体受伤的常见策略，福尔斯跌倒导致97%的老年人上肢骨折，76%的手腕骨折是由于直接撞击手腕造成的。 手因此，自然和响应的手臂动力学对于有效和安全的假肢的重要性可能对上肢丧失的人在不使用假肢或仅佩戴假肢进行特定的日常活动时具有重要意义。尽管对上肢假肢使用者的绝大多数研究都集中在功能使用上（例如，达到和抓），很少注意到他们的步态和站立平衡特性。因此，上肢丧失对行走和站立的影响，特别是与避免跌倒的能力有关的影响，仍然知之甚少。考虑到 手臂在保持直立平衡中的重要性，我们假设与身体健全的人相比，失去上肢的人将表现出改变的行走特征，这将产生不稳定性并增加他们福尔斯和与跌倒相关的损伤的风险。来自临床医生的轶事证据支持这一假设。因此，本项目的主要目的是探讨上肢丧失对福尔斯风险以及步态和站立平衡特征的影响。为了实现这一目标，将收集上肢缺失个体的定性和生物力学数据。将通过问卷调查收集腕部水平或近侧单侧或双侧上肢丧失的个体的病因、活动性和平衡信心以及跌倒史的定性数据。问卷将通过互联网、电话访谈和硬拷贝形式进行管理。将收集肘上和手肘下单侧肢体缺失的上肢假肢使用者的稳态步态和站立平衡的生物力学数据，同时：1）使用他们当前的假肢，2）不使用假肢，3）使用实验模拟（即，非功能性的）假肢，其匹配健全肢体的惯性特性。观察到的生物力学数据将包括先前显示的与老年人和其他倾向于不稳定的病理人群中的跌倒风险和不稳定相关的数据。将通过适当的重复测量统计方法分析组内差异，并应用回归分析开发上肢丧失个体的福尔斯预测模型。由于缺乏关于上肢丧失对福尔斯的影响以及行走和站立特征的信息，本项目的结果将为该主题提供急需的见解，并量化对该人群的未记录健康危害。随后的研究将集中在确定上肢假肢使用者不稳定的潜在机制。长期目标是制定有效的康复战略和加强技术（例如，改进的假肢设计），促进高效、安全的运动，减少福尔斯跌倒，增加日常参与，提高生活质量。