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?

[由于截肢造成的功能损害，有必要确定 康复策略的好处，如实时视觉反馈训练。这样的培训可以使 退伍军人进行经胫骨截肢(TTA)，以更好地利用他们的假体，并重新获得尽可能大的 职能级别。目前尚不清楚假肢装置(被动弹性假肢与电池假肢) 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。更好地使用假体，因为有针对性的真实- 时间视觉反馈训练能促进康复，改善功能，减少不对称 生物力学，这反过来可以减少常见的并发症，如骨关节炎，腿部和背部疼痛，以及 间接地，患有TTA的退伍军人中的糖尿病。拟议项目的目的是系统地建立 高峰期靶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)对患有TTA的退伍军人生物力学、代谢成本和肌肉活动的影响 使用他们自己的被动弹性假肢和电池供电的脚踝假肢。我们的结果是 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 双腿截肢。 以前的研究表明，使用被动弹性和/或动力踝足假体可能不会 优化退伍军人TTA行走功能。有针对性的实时视觉反馈培训 最大推进地面反作用力增加了老年人的推进力并改善了步行功能(&gt；65 年)和中风后的成年人，他们通常脚踝力量受损。据我们所知，没有研究表明 阐述了最大推进力的视觉反馈如何影响被动弹性或动力脚踝的使用 有TTA的人做的脚部假体。在拟议的研究中，我们将确定潜在的新陈代谢 有针对性的实时视觉反馈训练产生的成本、生物力学、稳定性和肌肉活动 峰值推进力以确定患有TTA的退伍军人如何从更有效地使用被动弹性装置中受益 假体和/或电池供电的踝足假体，并确定是否增加机械动力 由电池供电的踝足假体可以进一步增强退伍军人的功能 步行时的单侧TTA。30名患有单侧TTA的退伍军人将使用他们自己的被动弹性假体 在平地行走中进行视觉反馈训练和不进行视觉反馈训练，同时测量他们的新陈代谢 成本和生物力学。然后，他们将使用动力踝足假体(Empower，BionX，Ottoock) 在平地行走中进行视觉反馈训练和不进行视觉反馈训练，同时测量他们的新陈代谢 成本和生物力学。对于每个假体，受试者将在双腰带测力上以1.25m/S的速度行走 跑步机1)没有视觉反馈，然后具有实时视觉反馈：2)来自 无反馈状态，3)峰值推力增加20%，4)峰值推力增加40% 武力。在这些视觉反馈试验中，我们将要求受试者匹配显示的峰值推进力 电脑屏幕上有他们受影响的腿。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。我们将确定患有TTA的退伍军人是否使用实时视觉 峰值推进力的反馈训练可以改善代谢成本、生物力学对称性和 动态稳定性/平衡性，同时使用自己的被动弹性假体或动力踝足假体。 我们还将确定患有TTA的退伍军人是否可以保留由以下因素引起的代谢和生物力学好处 删除反馈后进行实时视觉反馈培训。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，最大限度地 功能，并改善有交通援助的退伍军人的生活质量。]

[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.]