User-Controlled Variable Stiffness Prosthesis to Improve Amputee Balance

用户控制的可变刚度假肢可改善截肢者的平衡

基本信息

批准号：
9278013
负责人：
Glenn Klute
金额：
--
依托单位：
VA PUGET SOUND HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9278013
关键词：
Address Afghanistan Age Aging Algorithms American Amputees Ankle Caring Clinical Complex Complications of Diabetes Mellitus Computer Simulation Conflict (Psychology)Data Devices Diabetes Mellitus Dimensions Electromyography Equilibrium Exhibits Floor Freedom Future Gait Generations Growth High Prevalence Hip region structure Home environment Human Ice Individual Injury Intervention Iraq Knowledge Laboratories Laws Left Liquid substance Lower Extremity Measurement Measures Military Personnel Modeling Motor Muscle Musculoskeletal Nature Oils Outcome Measure Output Overweight Pattern Recognition Perception Population Property Prosthesis Reaction Recovery Reporting Research Risk Surface Technology Testing Time To specify Translating Veterans Walking cohort design experimental study falls foot human subject improved innovation instrument limb amputation novel operation powered prosthesis prevent public health relevance rehabilitative care research and development response stem

项目摘要

DESCRIPTION (provided by applicant): Project Summary (Public Abstract) Many lower limb amputees have difficulty maintaining balance while walking, especially in real-world situations that require quick responses to changes in terrain or surface conditions. To be certain, amputees (and others) can fall in a myriad of ways for a myriad of reasons. Unexpected slipping on a surface (e.g., due to ice, oil or other liquids on the surface) is an example of a class of falls where it is difficult to imagine a prosthetic intervention that might prevent loss of balance. Stepping on uneven terrain is a different class where we suggest a novel prosthesis might aid in balance recovery. A quarter of outdoor falls, where a wide variety of uneven terrains exist, occur in a sideways (mediolateral) direction. Maintaining balance when stepping on uneven terrain can be particularly difficult for lower limb amputees because they lack the foot-ankle muscles needed to compensate and their prostheses are passive, elastic devices whose properties cannot change or adapt. The purpose of this research is to improve the balance of lower limb amputees by providing them with an optimized prosthesis that can respond to their motor intentions and adapt to changes in terrain. To address this important issue faced by Veteran lower limb amputees, we have already developed an advanced computer modeling and simulation framework, which we will use to identify the optimal ankle properties that maximize balance recovery after a step on uneven terrain. We have also built a first generation prosthesis with variable coronal plane ankle stiffness and tested it with the help of amputees walking on a novel instrumented walkway that replicates a step on uneven terrain. The results of our preliminary tests suggest that varying coronal plane ankle stiffness can influence how an amputee controls their balance. Our proposed research has three specific aims: (1) To identify terrain-dependent coronal ankle properties that maximize balance recovery. We propose to develop a three-dimensional bipedal musculoskeletal model of human walking on uneven terrain and use it to answer a key question: What is the optimal coronal plane stiffness that maximizes balance recovery after a step on uneven terrain? (2) To identify user motor intentions before a step on uneven terrain. We propose to conduct a human subject experiment (n=20) with transtibial amputees wearing our first generation prosthesis. Subjects will be asked to walk on our instrumented walkway that replicates a single step on uneven terrain while we measure their motor intentions (surface electromyography). Using the experimental results, we will develop and test three algorithms to predict the step on uneven terrain. We hypothesize that there will be a difference in accuracy among the three algorithms. We will use the results to specify a control law that best predicts a step on uneven terrain for use with our novel prosthesis. (3) Determine if a novel prosthesis optimized for balance recovery and controlled by user motor intentions can improve the recovery from a step on uneven terrain when compared to the amputee's as- prescribed prosthesis. To achieve this aim, we propose to build a second generation prosthesis that incorporates the results from Specific Aims 1 and 2, as well as the lessons learned from our first generation prosthesis. We then propose to conduct a human subject experiment with transtibial amputees (n=20) that will measure their balance recovery after a step on uneven terrain. We hypothesize that our novel prosthesis will improve the recovery of balance after a step on uneven terrain when compared to the amputee's as-prescribed prosthesis. Expanding the terrain over which Veteran amputees can confidently walk is where the VA should be: at the forefront of prosthetic technology and prescription practice that advances amputee care.

描述（由申请人提供）：项目摘要（公共摘要）许多下肢截肢者在步行时难以保持平衡，尤其是在现实情况下，需要快速响应地形或表面状况的变化。可以肯定的是，出于多种原因，截肢者（和其他人）可能以多种方式掉下来。意外的在表面上滑动（例如，由于冰，油或表面上的其他液体）是一类跌倒的一个例子，很难想象一种假肢干预可能会阻止平衡的损失。踏上不平坦的地形是另一个不同的阶级，我们建议新的假体可能有助于平衡恢复。侧向（内侧）方向出现了四分之一的户外瀑布，那里存在着各种各样的不平衡地形。对于下肢截肢者而言，保持平均水平时保持平衡可能特别困难，因为它们缺乏补偿所需的脚部轴肌肉，其假体是被动的，其性能无法改变或适应的弹性设备。这项研究的目的是通过为他们提供优化的假体来改善下肢截肢者的平衡，以响应其运动意图并适应地形的变化。为了解决资深下肢截肢者面临的这一重要问题，我们已经开发了一个高级的计算机建模和仿真框架，我们将使用该框架来识别最佳的脚踝属性，这些属性在不平坦的地形上迈出了一步之后最大化平衡恢复。我们还建立了一个具有可变冠状平面踝僵硬的第一代假体，并在截肢者在新颖的乐器人行道上行走的帮助下对其进行了测试，该步行道上在不平坦的地形上复制了一步。我们的初步测试的结果表明，不同的冠状平面踝僵硬可以影响截肢者如何控制其平衡。我们提出的研究具有三个特定的目的：（1）确定依赖地形的冠状踝关节特性，以最大程度地恢复平衡。我们建议开发人类在不平坦的地形上行走的三维两维肌肉骨骼模型，并使用它来回答一个关键问题：最佳的冠状平面刚度是什么，在不平衡的地形上一步之后，最大化平衡恢复是什么？（2）在不平坦的地形上一步前识别用户电动机意图。我们建议用穿着第一代假体的跨性别截肢者进行人类主题实验（n = 20）。将要求受试者在我们的仪器人行道上行走，该人行道在我们测量其运动意图（表面肌电图）的同时，在不平坦的地形上复制一步。使用实验结果，我们将开发和测试三种算法，以预测地形不平的步骤。我们假设三种算法之间的准确性会有所不同。我们将使用结果来指定控制法律，该法律可以最好地预测与我们新颖的假体一起使用的不均匀地形。（3）确定与截肢者的ASPREADER假体相比，针对平衡恢复和通过用户电动机控制的新颖假体是否可以改善从不平坦地形的步骤的恢复。为了实现这一目标，我们建议建立第二代假体，该假体结合了特定目标1和1的结果，以及从第一代假体中学到的经验教训。然后，我们建议进行人类主题实验（n = 20），该实验将在不平坦的地形上一步之后衡量其平衡恢复。我们假设，与截肢者的ASPRECTER假体相比，我们的新颖假体将在不平坦的地形上一步之后提高平衡的恢复。扩大资深截肢者可以自信地走的地形是VA的所在地：位于假肢技术和处方实践的最前沿，可以推进截肢者的护理。