How Do Lower Limb Prosthetic Stiffness and Power Affect the Biomechanics, Metabolic Costs, and Satisfaction of Veterans with Transtibial Amputations DuringWalking?

下肢假肢刚度和力量如何影响小腿截肢退伍军人步行时的生物力学、代谢成本和满意度？

• 批准号: 10652963
• 负责人: Alena Grabowski
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10652963
• 关键词: Affect; Amputation; Ankle; Back Pain; Biological; Biomechanics; Categories; Computer software; Degenerative polyarthritis; Diabetes Mellitus; Felis catus; Germany; Goals; Health; Health Care Costs; Impairment; Individual; Joints; Kinetics; Knee; Lead; Leg; Limb Prosthesis; Lower Extremity; Manufacturer Name; Materials Testing; Measures; Mechanics; Metabolic; Movement; Muscle; Obesity; Osteoporosis; Output; Pain in lower limb; Participant; Persons; Phase; Physical Function; Physical activity; Property; Prosthesis; Prosthesis Design; Quality of life; Questionnaires; Recommendation; Recovery; Rehabilitation therapy; Resources; Risk; Savings; Series; Services; Shapes; Shoes; Speed; Technology; Testing; Time; Torque; Torsion; Veterans; Walking; Work; ankle prosthesis; base; comorbidity; cost; evidence base; foot; functional disability; functional restoration; improved; improved functioning; in vivo; kinematics; mechanical energy; pain reduction; powered prosthesis; prosthesis control; prosthetic foot; rehabilitation research; research and development; satisfaction; treadmill; walking speed

Previous studies suggest that use of the recommended prosthetic foot stiffness category and/or ankle power output setting may not optimize the function of Veterans with transtibial amputations (TTAs). Due to the functional impairments and lifetime of healthcare costs incurred by Veterans with TTAs, it is vital to determine how different prosthetic foot and ankle properties/parameters such as passive-elastic prosthetic foot stiffness and battery-powered prosthetic ankle power output affect the metabolic cost and biomechanics of Veterans with TTAs. Further, determining the optimal prosthetic foot stiffness and/or power output could dramatically improve the function of people with TTAs, which would promote increased physical activity, while reducing pain and the risk of comorbidities. Veterans with TTAs typically use a passive-elastic prosthetic foot such as the Össur Low Profile Vari-flex with Evo (LP) with a stiffness category based on manufacturer-recommendations, user body mass, and anticipated activity level. Previous evidence demonstrates that Veterans with TTAs using the recommended passive-elastic prosthetic foot stiffness category for walking have greater metabolic demands, asymmetric biomechanics, leg and back pain, and discomfort compared to non-amputees. Further, some Veterans use a battery-powered ankle-foot prosthesis such as the Ottobock BiOM. [The Össur Low Profile Vari-flex with Evo (LP) is the only passive-elastic prosthetic foot that integrates with the BiOM. The LP is utilized beneath (in-series with) the BiOM with a stiffness category based on manufacturer-recommendations, user body mass and activity level. Then, the BiOM is tuned by adjusting nine different parameters within the prosthesis using different software settings so that the combination of the user and prosthesis produce net positive prosthetic ankle work equivalent to average non-amputee net positive ankle work within two standard deviations (SD) of the mean. Use of BiOM has resulted in normative metabolic costs and biomechanics for people with TTAs compared to non-amputees, but one study found that use of the BiOM with a recommended LP prosthetic foot stiffness category and prosthetic power output setting did not elicit differences in metabolic cost at preferred walking speeds compared to use of participants’ own passive-elastic prosthesis.] We will systematically assess how prosthetic foot stiffness and power output affect physical function in Veterans with TTAs. First, we will quantify prosthetic and torsional stiffness (force/displacement or torque/angle) values of LP prostheses. Determining stiffness values (in kN/m and kN·m/rad) for a given passive-elastic prosthetic foot stiffness category is essential for deriving the dynamic biomechanical function of prosthetic feet. Then, we will systematically measure and compare the metabolic cost, biomechanics, muscle activity, and satisfaction resulting from using the LP passive-elastic prosthetic foot alone with four stiffness categories, and the BiOM battery-powered ankle-foot prosthesis combined with four LP prosthetic foot stiffness categories and three different magnitudes of prosthetic ankle power output during walking over a range of speeds. Our results will provide a mechanistic understanding of prosthetic stiffness and power to inform prosthetic design and control, which will improve and expedite rehabilitation of Veterans with TTAs and the quality of services provided by the VA, while saving time, money, and resources. By improving prosthetic design and control, our results could ultimately allow Veterans with TTAs to regain the greatest possible level of physical function, improve their health, maximize their recovery and rehabilitation, facilitate their return to work/duty, and potentially improve their quality of life. Long-term goals for prosthetic design should include “smarter” prostheses that can change stiffness dynamically, generate net positive mechanical work, and dissipate mechanical work. However, a critical barrier to developing such advanced prostheses is our lack of a fundamental understanding of the effects of different prosthetic foot stiffness and power output on the metabolic costs, biomechanics, and satisfaction of Veterans with TTAs during level-ground walking.

以前的研究表明，使用推荐的假足刚度类别和/或踝关节 功率输出设置可能无法优化经胫骨截肢（TTA）退伍军人的功能。由于 功能障碍和医疗费用的一生与TTA的退伍军人所产生的，这是至关重要的，以确定 不同的假足和踝关节特性/参数，如被动弹性假足刚度 和电池驱动的假肢踝关节功率输出影响退伍军人的代谢成本和生物力学 关于TTA此外，确定最佳假足刚度和/或功率输出可以显著地 改善TTA患者的功能，这将促进增加体力活动，同时减少疼痛 和合并症的风险。患有TTA的退伍军人通常使用被动弹性假足，例如 Össur Low Profile Vari-Flex with Evo（LP），刚度类别基于制造商建议， 用户体重和预期活动水平。以前的证据表明，使用TTA的退伍军人 推荐用于行走的被动弹性假足刚度类别具有更大的代谢 需求，不对称的生物力学，腿部和背部疼痛，以及与非截肢者相比的不适。此外，本发明还 一些退伍军人使用电池供电的踝足假肢，如奥托博克生物机械。[The厄苏尔洛 Profile Vari-flex with Evo（LP）是唯一一款与BiOM集成的被动弹性假足。LP是 在BiOM下方（与BiOM串联）使用，刚度类别基于制造商建议， 用户体重和活动水平。然后，通过调整九个不同的参数来调整BiOM。 假体使用不同的软件设置，以便用户和假体的组合产生净 假肢踝关节正功相当于两个标准内的平均非截肢者净踝关节正功 平均值的偏差（SD）。使用BiOM导致正常的代谢成本和生物力学， 与非截肢者相比，患有TTA的人，但一项研究发现， LP假足刚度类别和假体功率输出设置未引起代谢差异， 与使用参与者自己的被动弹性假体相比，在优选的步行速度下的成本。 我们将系统地评估假足刚度和功率输出如何影响身体功能， 有TTA的退伍军人首先，我们将量化假体和扭转刚度（力/位移或 扭矩/角度）值。确定给定的刚度值（kN/m和kN·m/rad） 被动弹性假足刚度类别对于导出 假脚然后，我们将系统地测量和比较代谢成本，生物力学，肌肉 活动，并单独使用LP被动弹性假肢脚与四个刚度的满意度 类别，以及BiOM电池供电的踝足假肢与四个LP假肢脚刚度相结合 类别和三种不同幅度的假肢踝关节功率输出在步行过程中的范围 速度.我们的研究结果将提供一个机械的了解假肢刚度和权力， 假肢的设计和控制，这将改善和加快与TTA退伍军人的康复， 提高VA提供的服务质量，同时节省时间、金钱和资源。通过改进假肢 通过设计和控制，我们的结果最终可以让患有TTA的退伍军人恢复最大可能的水平 身体功能，改善他们的健康，最大限度地恢复和康复，促进他们返回 工作/职责，并有可能提高他们的生活质量。假肢设计的长期目标应包括 “更智能”的假肢，可以动态地改变刚度，产生净正机械功， 消耗机械功。然而，开发这种先进假体的一个关键障碍是我们缺乏 基本了解不同的假足刚度和功率输出对 代谢成本，生物力学，和满意度的退伍军人与TTA在平地行走。