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

描述(由申请人提供)： 自然手臂动力学在行走过程中起着至关重要的作用，尤其是在面对突然的扰动时，为了确保高效稳定的行走和避免摔倒。因此，在健全的步态中，限制手臂摆动会增加代谢成本，损害侧向稳定性，并干扰自然行走动力学。重要的是，张开双臂止住跌倒是避免身体受伤的常见策略，跌倒导致97%的老年人上肢骨折，76%的手腕骨折是由直接撞击身体造成的。 手。因此，对于不使用假肢或只在特定的日常活动中佩戴假肢的上肢丧失患者来说，自然和反应灵敏的手臂动力学对有效和安全步行的重要性可能具有重要意义。虽然大多数关于上肢假体使用者的研究都集中在功能性使用(如伸手和抓取)上，但很少有人关注他们的步态和站立平衡特征。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。鉴于 由于手臂在保持直立平衡方面的重要性，我们假设，与健全的人相比，失去上肢的人将表现出不同的行走特征，这将造成不稳定，并增加他们摔倒和摔倒相关伤害的风险。来自临床医生的轶事证据支持了这一假设。因此，本项目的主要目标是探讨上肢丧失对跌倒风险的影响以及步态和站立平衡的特点。为了实现这一目标，将收集上肢丧失患者的定性和生物力学数据。关于病因、活动度和平衡信心以及跌倒病史的定性数据将通过调查问卷收集，调查对象为手腕水平或接近手腕水平的单侧或双侧上肢缺失患者。调查问卷将通过互联网、电话采访和硬拷贝形式进行管理。当上肢假肢使用者在肘部上方和下方失去单侧肢体时，将收集其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，以及3)使用与健全肢体的惯性特性相匹配的实验性模拟(即非功能性)假肢。观察到的生物力学数据将包括那些先前被证明与老年人和其他易失稳的病理人群的跌倒风险和不稳定性有关的数据。将通过适当的重复测量、统计方法和回归分析来分析组内差异，并将应用回归分析来开发上肢丧失个体跌倒的预测模型。由于缺乏关于失去上肢对跌倒的影响以及行走和站立特征的信息，该项目的结果将为这一主题提供亟需的见解，并量化对这一人群的未记录的健康危害。随后的研究将集中于确定上肢假体使用者不稳定的潜在机制。长期目标是开发有效的康复策略和改进的技术(例如，改进的假肢设计)，以促进高效和安全的运动，并减少跌倒，增加日常参与，并提高生活质量。

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.