Can Sensory Feedback Training Improve the Biomechanical and Metabolic Effects of Using Passive or Powered Lower Limb Prostheses During Walking for Veterans with Transtibial Amputations?

[Due对于下肢截肢引起的功能障碍，必须确定 康复策略的好处，如实时视觉反馈训练。这样的培训可以让 接受经胫骨截肢（TTA）的退伍军人更好地利用他们的假体， 功能水平。目前尚不清楚假肢装置（被动弹性假肢脚与电池） 动力踝足假体）和/或使用者对假体的反应有助于生物力学 以及在行走过程中使用这些假肢的代谢影响。由于有针对性的真实的- 时间视觉反馈训练可促进康复，改善功能，减少不对称 生物力学，这反过来又可以减少常见的合并症，如骨关节炎，腿部和背部疼痛， 间接地，患TTA的退伍军人的糖尿病。拟议项目的目的是系统地建立 峰值推进力定向实时视觉反馈训练的代谢和生物力学效应 地面反作用力（GRF）对TTA退伍军人的生物力学、代谢成本和肌肉活动的影响 使用他们自己的被动弹性假脚和电池供电的踝足假肢。的成果 研究可以加强假肢技术的使用，以改善退伍军人的康复和功能 下肢截肢 以前的研究表明，使用被动弹性和/或动力踝足假肢可能不会 在行走过程中优化具有TTA的退伍军人的功能。有针对性的实时视觉反馈训练， 峰值推进地面反作用力增加了老年人（>65岁）的推进力和改善的行走功能 年）和中风后的成年人，他们通常有受损的踝关节力量。据我们所知，没有任何研究 解决了峰值推进力的视觉反馈如何影响被动弹性或动力踝关节的使用， TTA患者的假肢。在拟议的研究中，我们将确定潜在的代谢 成本，生物力学，稳定性和肌肉活动，从有针对性的实时视觉反馈训练， 峰值推进力，以确定如何退伍军人与TTA受益于更有效地使用被动弹性 假体和/或电池供电的踝-足假体，并且确定机械动力的增加是否 由电池供电的踝足假肢提供，可以进一步增强退伍军人的功能， 步行时单侧TTA。30名单侧TTA的退伍军人将使用自己的被动弹性假体 在平地行走过程中，无论是否进行视觉反馈训练， 成本和生物力学。然后，他们将使用动力踝足假肢（emPOWER，BiONX，Ottobock） 在平地行走过程中，无论是否进行视觉反馈训练， 成本和生物力学。使用每种假肢，受试者将在双带测力仪上以1.25 m/s的速度行走。 跑步机1）没有视觉反馈，然后有实时视觉反馈：2）峰值推进力， “无反馈”条件下，3）+20%更大的峰值推进力，和4）+40%更大的峰值推进力 力在这些视觉反馈试验中，我们将要求受试者匹配显示在屏幕上的峰值推进力。 一个电脑屏幕与他们受影响的腿。我们还将要求受试者：5）匹配对称的视觉反馈， 双腿的最大推进力我们将确定是否退伍军人与TTA利用实时视觉 峰值推进力的反馈训练可以改善代谢成本，生物力学对称性， 动态稳定性/平衡，同时使用自己的被动弹性假肢或动力踝足假肢。 我们还将确定是否有TTA的退伍军人可以保留代谢和生物力学的好处， 实时视觉反馈训练，一旦反馈被删除。拟议项目的结果将是 用于为康复策略和假肢设计提供信息，最终可以改善健康， 功能，并提高生活质量的退伍军人与TTA。

[Due to the functional impairments caused by a lower limb amputation, it is essential to determine the benefits of rehabilitation strategies such as real-time visual feedback training. Such training could allow Veterans with transtibial amputations (TTAs) to better utilize their prostheses and regain the greatest possible level of function. It is not clear how much the prosthetic device (passive-elastic prosthetic foot versus battery- powered ankle-foot prosthesis) and/or the user’s response to the prosthesis contribute to the biomechanical and metabolic effects of using these prostheses during walking. Better use of a prosthesis due to targeted real- time visual feedback training could enhance rehabilitation, improve function and reduce asymmetric biomechanics, which in turn could reduce common comorbidities such as osteoarthritis, leg and back pain, and indirectly, diabetes in Veterans with TTAs. The purpose of the proposed project is to systematically establish the metabolic and biomechanical effects of targeted real-time visual feedback training of peak propulsive ground reaction force (GRF) on the biomechanics, metabolic costs, and muscle activity of Veterans with TTAs using their own passive-elastic prosthetic foot and a battery-powered ankle-foot prosthesis. The results of our research could enhance the use of prosthetic technology to improve the rehabilitation and function of Veterans with lower limb amputations. Previous studies suggest that use of passive-elastic and/or powered ankle-foot prostheses may not optimize the function of Veterans with TTAs during walking. Targeted, real-time visual feedback training of peak propulsive ground reaction forces increased propulsion and improved walking function in older (>65 years) and post-stroke adults, who typically have impaired ankle power. To our knowledge, no research has addressed how visual feedback of peak propulsive force affects the use of passive-elastic or powered ankle- foot prostheses by people with TTAs. In the proposed research, we will determine the underlying metabolic costs, biomechanics, stability, and muscle activity resulting from targeted real-time visual feedback training of peak propulsive force to identify how Veterans with a TTA benefit from more effective use of a passive-elastic prosthesis and/or a battery-powered ankle-foot prosthesis and to determine if the addition of mechanical power provided by a battery-powered ankle-foot prosthesis can further enhance the function of Veterans with unilateral TTAs during walking. 30 Veterans with unilateral TTAs will use their own passive-elastic prosthesis both with and without visual feedback training during level-ground walking, while we measure their metabolic costs and biomechanics. Then, they will use a powered ankle-foot prosthesis (emPOWER, BiONX, Ottobock) both with and without visual feedback training during level-ground walking, while we measure their metabolic costs and biomechanics. With each prosthesis, subjects will walk at 1.25 m/s on a dual-belt force-measuring treadmill 1) with no visual feedback, and then with real-time visual feedback of: 2) peak propulsive force from the “no feedback” condition, 3) +20% greater peak propulsive force, and 4) +40% greater peak propulsive force. During these visual feedback trials, we will ask subjects to match the peak propulsive force displayed on a computer screen with their affected leg. We will also ask subjects to: 5) match symmetric visual feedback of the peak propulsive force from both legs. We will determine if Veterans with TTAs utilizing real-time visual feedback training of peak propulsive force can improve metabolic costs, biomechanical symmetry, and dynamic stability/balance, while using their own passive-elastic prosthesis or a powered ankle-foot prosthesis. We will also establish if Veterans with TTAs can retain the metabolic and biomechanical benefits elicited by real-time visual feedback training once that feedback is removed. Results from the proposed project will be used to inform rehabilitation strategies and prosthetic design, which could ultimately improve health, maximize function, and improve quality of life for Veterans with TTAs.]