Optimizing Prosthetic and Bicycle Fit for Veterans with Transtibial Amputations

美国有100多万人截肢，而且这个数字还在继续增长，原因是 糖尿病的流行和最近的军事冲突。因为一种运动引起的功能障碍 截肢，极其重要的是推进康复，优化假肢的使用，以便 截肢的退伍军人可以恢复尽可能多的健康、功能和体力活动。 [低冲击性运动，如骑自行车，可通过改善以下方面促进截肢后重返工作/工作岗位 退伍军人经胫骨截肢患者的心血管适应性、肌肉力量、耐力和生活质量 (TTA)。骑自行车作为运动还可以预防血管疾病和糖尿病的有害影响 改善心血管功能，控制体重，降低再截肢率，提高 有助教的退伍军人的生活质量。然而，很可能不适和增加的可能性 由于缺乏适当的假体/自行车匹配而导致的继发性肌肉骨骼损伤阻碍了患有TTA的退伍军人 使用自行车进行康复和锻炼。此外，目前还不清楚假肢和自行车 假体前足下方的组件，如塔架长度(PL)、踏板附着位置(PAP) 相对于塔架，以及曲柄臂长(CAL)影响生物力学、代谢成本和舒适性/ 退伍军人对TTA的满意度。因此，我们的目标是通过发展 循证假体和自行车适配指南，优化生物力学、代谢成本、效率 (机械动力/新陈代谢动力)和对退伍军人的舒适度/满意度。]美国商务部 退伍军人事务部(VA)和国防部(DoD)康复指令提出了一项倡议， 旨在显著改善和恢复受伤退伍军人和服役人员的功能，以便他们 可以选择重返现役岗位，也可以选择从事生产性文职工作。我们提议的研究将确立 最佳假肢/自行车适配指南，通过改善心血管健康来增强功能， 控制体重，降低再截肢率，提高退伍军人TTA的生活质量， 从而有助于实现这一倡议，并具有很高的潜在影响。具体来说，我们的目标是：1)研究15 有单侧TTA的退伍军人确定系统地改变PL，PAP在 假肢前脚与支架的对比，以及骑自行车时患腿的CAL生物力学，代谢成本， 和舒适/满足。2)综合和传播我们的发现，使之成为实用的、基于证据的量化方法 退伍军人助教义肢/自行车适配指南。我们假设较长的PL和较短的CAL 受影响的腿与未受影响的腿相比，与塔下的PAP相比 前足将最大化机械力量的对称性，减少代谢成本和肌肉活动，从而 单侧TTA的退伍军人在骑自行车时最大限度地提高效率和舒适性/满意度。[利用率 基于证据的假体/自行车适配指南，增加对称性，改善舒适性，降低 伤害、降低代谢成本和提高效率将直接使患有TTA的退伍军人受益 他们的身体活动和功能。]优化的假肢/自行车适配指南将允许退伍军人TTA 以前不能舒适地骑自行车的人，以及那些现在骑自行车的人，骑得更长 以更少的努力和不适，潜在地导致生活质量的提高。此外， 这项研究产生的假肢/自行车适配指南将确保临床医生能够适配退伍军人 与自行车的TTA更有效，导致预约时间更短，并减少重访，因为 增强了功能，减少了并发症。

Over one million people in the United States have a leg amputation and this number continues to grow due to the prevalence of diabetes and recent military conflicts. Because of the functional impairment caused by an amputation, it is extremely important to advance rehabilitation that optimizes the use of prostheses so that Veterans with amputations can regain the greatest possible level of health, function, and physical activity. [Low-impact exercise such as bicycling could facilitate return to work/duty after amputation by improving cardiovascular fitness, muscle strength, endurance, and quality of life for Veterans with transtibial amputations (TTAs). Bicycling as exercise could also prevent the deleterious effects of vascular disease and diabetes by improving cardiovascular function, controlling body weight, decreasing the rate of re-amputation, and improving quality of life for Veterans with TTAs. However, it is likely that discomfort and the increased potential for secondary musculoskeletal injury due to the lack of a proper prosthetic/bike fit discourages Veterans with TTAs from using bicycling for rehabilitation and exercise. Moreover, it is unclear how prosthetic and bicycle components, such as pylon length (PL), pedal attachment position (PAP) beneath the prosthetic forefoot versus the pylon, and crank arm length (CAL) affect the biomechanics, metabolic costs, and comfort/ satisfaction of Veterans with TTAs. Thus, our goal is to challenge the state-of-the-science by developing evidence-based prosthetic and bicycle fit guidelines that optimize the biomechanics, metabolic costs, efficiency (mechanical power/metabolic power) and comfort/satisfaction for Veterans with TTAs.] The Department of Veterans Affairs (VA) and Department of Defense (DoD) Rehabilitation Directive has put forth an initiative that aims to dramatically improve and restore function in wounded Veterans and Service members so that they have the choice to return to active duty or productive civilian employment. Our proposed research will establish optimal prosthetic/bicycle fit guidelines, which would enhance function by improving cardiovascular health, controlling body weight, decreasing re-amputation rates, and enhancing quality of life of Veterans with TTAs, thus helping to fulfill this initiative and having high potential impact. Specifically, we aim to: 1) Study 15 Veterans with unilateral TTAs to determine the effects of systematically varying PL, PAP beneath the prosthetic forefoot versus the pylon, and CAL for the affected leg on bicycling biomechanics, metabolic costs, and comfort/satisfaction. 2) Synthesize and disseminate our findings into practical, evidence-based quantitative prosthetic/bicycle fit guidelines for Veterans with TTAs. We hypothesize that a longer PL and shorter CAL for the affected compared to the unaffected leg along with a PAP beneath the pylon compared to beneath the forefoot will maximize mechanical power symmetry and reduce metabolic cost and muscle activity, and thus maximize efficiency and comfort/satisfaction during bicycling in Veterans with unilateral TTAs. [The utilization of evidence-based prosthetic/bicycle fit guidelines that increase symmetry, improve comfort, reduce the risk of injury, decrease metabolic costs, and improve efficiency will directly benefit Veterans with TTAs by increasing their physical activity and function.] Optimized prosthetic/bicycle fit guidelines will allow Veterans TTAs who were previously unable to comfortably ride a bicycle, as well as those currently riding a bicycle, to ride longer with less effort and discomfort, potentially leading to an improved quality of life. Moreover, the prosthetic/bicycle fit guidelines generated by this research will ensure that clinicians are able to fit Veterans with TTAs to bicycles more effectively, leading to shorter appointment times and fewer revisits due to enhanced function and reduced comorbidities.