Locomotor Response of Persons with Upper Limb Loss to Treadmill Perturbations

上肢丧失者对跑步机扰动的运动反应

• 批准号: 10013666
• 负责人: Matthew J. Major
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013666
• 关键词: Address; Affect; Award; Behavior; Biomechanics; Body mass index; Burn injury; Custom; Data; Economic Burden; Educational Intervention; Electromyography; Epidemiology; Equilibrium; Funding; Future; Gait; Gender; Health; High Prevalence; Impairment; Individual; Infrastructure; Injury; Integrated Health Care Systems; Intervention; Investigation; Knowledge; Lead; Left; Length; Limb Prosthesis; Limb structure; Lower Extremity; Measures; Methods; Motion; Multi-site clinical study; Muscle; Musculoskeletal Equilibrium; Optics; Outcome; Participant; Patient Care; Patients; Persons; Physiologic pulse; Pilot Projects; Posture; Preparation; Prevalence; Prosthesis; Public Health; Quality of life; Recovery; Rehabilitation therapy; Reporting; Research; Side; System; Technology; Time; Treatment Efficacy; Upper Extremity; Veterans; Walking; Wireless Technology; Work; Wrist; arm; balance prosthesis; base; cost; epidemiology study; equilibration disorder; experience; fall risk; falls; improved; individual response; kinematics; programs; prosthesis wearer; response; sensor; sound; spatiotemporal; standard of care; treadmill; walking stability

The primary aim of this pilot study is to characterize the proactive and reactive locomotor response of Veterans with upper limb loss (ULL) to a trip during walking. Our recent VA-funded (RX001388, RX001322) investigations have suggested that persons with ULL experience a high prevalence of falls and demonstrate postural control mechanisms that may impair stability. Specifically, nearly half of individuals with ULL at or proximal to the wrist level experience at least one fall per year and almost a third will experience two or more falls. Further, use of a prosthesis increases the likelihood of falling by six times, 25% of reported falls resulted from tripping, and nearly a third of individuals who experience a fall suffer a fall-related injury. Falls can have considerable economic burden on the VHA and lead to long-term diminished quality of life. Our biomechanical studies suggest that persons with unilateral ULL display greater postural sway during standing than able-bodied individuals which increases when wearing a prosthesis, and right/left asymmetry in locomotor stability dynamics that may [increase the risk of falling toward the impaired limb side and during sound limb side strides]. These findings emphasize the need for additional research to better understand the mechanisms Veterans with ULL use to control balance and how [wearing a] prosthesis [affects] these strategies. As our previous research was concerned with steady- state characterization of postural control, we now plan to build on this work by studying the effects of ULL and [wearing a] prosthesis on locomotor stability when responding to a trip disturbance during walking. In this context, locomotor stability is defined as the ability to recover from a perturbation and return to steady-state gait. We will address the study aims by analyzing trip-induced proactive and reactive locomotor strategy differences in two study comparisons: 1) Veterans with unilateral transradial level ULL against matched able-bodied controls [(with and without one arm bound)], and 2) Veterans with unilateral transradial ULL when wearing their customary prosthesis against not wearing their prosthesis. Controlled, yet unexpected, simulated trips will be delivered through our custom-built treadmill which permits programmable belt velocity disturbances and allows participants to continue walking following recovery. We will characterize the proactive and reactive locomotor [stability mechanisms] through a set of biomechanical (spatiotemporal, angular momentum, arm and trunk kinematics, recovery step length and time) and electromyography (upper and lower limb muscle activation timing and effort) variables. Biomechanical variables will be quantified using an optical motion capture system, and electromyography will be collected with a wireless sensor system. All data will be synchronized with each other and a time pulse denoting the onset of the treadmill perturbation. We expect that Veterans with ULL will demonstrate [altered] locomotor stability [mechanisms] compared to controls, and [these differences will exist between wearing and not wearing] their customary prosthesis. Results from this study will help us characterize the underlying mechanisms of locomotor stability in Veterans with ULL and identify the factors associated with their increased prevalence of trip-related falls. Such knowledge is a critical first step to addressing this public health problem through stability-targeted rehabilitation interventions aimed at reducing falls, fall-related injuries, and associated VHA costs in this Veteran patient group. We will use the outcomes from this pilot study to guide future VA Merit Award proposals to [develop and] assess [physical training] intervention methods and [wearable and prosthetic technology to improve stability in Veterans with ULL]. The VHA is an ideal venue to pursue this work as one of its main priorities is to elevate the standard-of-care for Veterans with limb loss.

这项初步研究的主要目的是描述退伍军人的主动性和反应性运动反应。 在步行过程中，由于绊倒导致上肢丧失(ULL)。我们最近由退伍军人事务部资助的(RX001388，RX001322)调查 都表明ULL患者跌倒的发生率很高，并表现出姿势控制 可能损害稳定性的机制。具体地说，近一半的ULL患者在手腕或手腕附近 水平每年至少经历一次跌倒，几乎三分之一的人会经历两次或更多跌倒。此外，使用 假体使跌倒的可能性增加了6倍，25%的报告跌倒是由绊倒造成的，几乎 经历过跌倒的人中有三分之一会遭受与跌倒相关的伤害。瀑布可能会带来可观的经济 对VHA造成负担，并导致长期生活质量下降。我们的生物力学研究表明 单侧ULL的人在站立时的姿势摆动比健全的人更大 戴假体时增加，运动稳定性动力学中的右/左不对称可能增加[增加 向受损肢体一侧跌倒的风险，以及在健全的肢体侧步中的风险]。这些发现强调了 需要更多的研究来更好地了解患有ULL的退伍军人控制平衡的机制 以及[佩戴]假肢如何[影响]这些策略。因为我们之前的研究关注的是稳定- 姿势控制的状态表征，我们现在计划在此工作的基础上，通过研究ULL和 在行走过程中应对绊倒干扰时，[佩戴]假肢对运动稳定性的影响。在这方面， 运动稳定性被定义为从扰动中恢复并恢复到稳定步态的能力。 我们将通过分析出行诱导的主动性和反应性运动策略的差异来解决研究目标 在两项研究中的比较：1)患有单侧经桡水平ULL的退伍军人与匹配的健全对照 [(捆绑和不捆绑一只手臂)]]，以及2)退伍军人在穿着他们惯常的衣服时患有单侧经桡动脉ULL 假肢与不戴假肢的对比。将提供受控但意想不到的模拟行程 通过我们定制的跑步机，它允许可编程的皮带速度扰动，并允许参与者 在康复后继续行走。我们将描述主动性和反应性运动者的[稳定性 机构]通过一套生物力学(时空、角动量、手臂和躯干运动学、 恢复步长和时间)和肌电图(上肢和下肢肌肉激活的时机和力度) 变量。生物力学变量将使用光学运动捕捉系统进行量化，以及 肌电记录将通过无线传感器系统进行采集。所有数据将彼此同步 以及表示跑步机扰动开始的时间脉冲。我们预计患有ULL的退伍军人将 与对照组相比，证明[改变]运动稳定性[机制]，[这些差异将存在 戴和不戴]他们惯用的假肢。这项研究的结果将有助于我们描述 退伍军人ULL患者运动稳定性的潜在机制及其相关因素 他们与旅行相关的跌倒的患病率增加。这些知识是解决这一问题的关键的第一步 通过以稳定性为目标的康复干预，旨在减少跌倒、跌倒相关伤害、 以及相关的VHA费用。我们将使用此试点研究的结果来指导 未来退伍军人荣誉奖建议[开发和]评估[体育锻炼]干预方法和[可穿戴设备 和假体技术，以提高患有ULL的退伍军人的稳定性]。VHA是追求这一目标的理想场所 作为其主要优先事项之一的工作是提高对肢体丧失的退伍军人的护理标准。