Toward Restoration of Normative Postural Control and Stability using Neural Control of Powered Prosthetic Ankles

项目总结 跌倒和害怕跌倒在接受下肢截肢(LLA)的人中普遍存在，这是一种大的和 这个国家不断增长的人口。LLA患者跌倒的发生率经常被报告为 需要调整姿势的活动。转移(例如，坐到站)和涉及动态平衡的活动 控制(例如伸手和转身)会导致血管障碍的经胫骨截肢者的许多跌倒。这一证据 强调迫切需要解决平衡和姿势稳定问题，以使有效的日常生活活动 患有LLA的个体。 目前的假肢技术不允许截肢者应用典型的姿势控制策略 假肢关节，限制姿势的稳定性，并产生额外的健康问题。相反，截肢者往往 制定残肢(未截肢)和完整肢体的代偿策略以控制平衡。这个 下肢失去活动自由度(例如脚踝和/或膝盖)显著限制了生物力学 可用于姿势控制的资源。 假体和神经接口技术的最新进展可能满足以下需求 改善了LLA患者的平衡和姿势稳定性；然而，相关研究强调 高效舒适的行走，而不是平衡和姿势控制。作为平衡和姿势控制 几乎所有的活动都是直立进行的，使用假体技术直接解决 截肢者的平衡稳定性是非常需要的，但在我们的领域中很少被研究。 这项建议的目的是调查训练使用直接肌电图仪(Demg)的效果。 动力假肢对经胫骨截肢者的控制(目标1)平衡和姿势稳定性(目标2) 神经肌肉控制和协调，以及(目标3)认知过程，与每日处方的被动相比较 设备。 该项目具有明显的临床意义，因为它解决了改善平衡和姿势的临床需求。 LLA患者的稳定性。使用DEMG控制的电动假体为用户提供了额外的 协助平衡稳定性和改善平衡信心的资源，这反过来又改善了他们的 社区参与和生活质量。同时，预计拟议的项目将有助于 对假体技术领域的重要知识，对电机领域的科学贡献 控制和学习、生物力学和认知-运动相互作用，并使物理治疗和截肢者受益 康复。

PROJECT SUMMARY Falling and fear of falling are pervasive amongst individuals with lower limb amputation (LLA), a large and growing population in the nation. The incidence of falls in individuals with LLA has been often reported during activities requiring adjustments in posture. Transfers (e.g., sit-to-stand) and activities involving dynamic balance control (e.g., reaching and turning) lead to many of the falls in dysvascular transtibial amputees. This evidence highlights the urgent need to address balance and postural stability to enable effective activities of daily living for individuals with LLA. Current prosthesis technology does not allow the amputee users to apply typical postural control strategies at prosthetic joints, limiting postural stability and yielding additional health concerns. Instead, amputees often develop compensatory strategies with the residual (unamputated) joints and intact limb to control balance. The loss of active degrees of freedom (e.g., ankle and/or knee) in the lower limb significantly limits the biomechanical resources available for postural control. Recent advancements in prosthesis and neural interfacing technologies potentially can address the need for improved balance and postural stability in individuals with LLA; however, the related research emphasizes efficient and comfortable walking, rather than balance and postural control. As balance and postural control underly almost all activities performed in an upright position, using prosthesis technologies to directly address the balance stability of amputees is highly needed but rarely investigated in our field. The objective of this proposal is to investigate the effects of training to use direct electromyographic (dEMG) control of a powered prosthetic ankle on transtibial amputees’ (Aim 1) balance and postural stability, (Aim 2) neuromuscular control and coordination, and (Aim 3) cognitive processes, compared to daily prescribed passive devices. This project has clear clinical significance since it addresses the clinical need for improved balance and postural stability in individuals with LLA. Use of dEMG-controlled powered prostheses provides users with additional resources to assist with balance stability and improve balance confidence, which, in turn, improves their community participation and quality of life. At the same time, the proposed project is expected to contribute important knowledge to the field of prosthesis technology, make scientific contributions to the fields of motor control and learning, biomechanics, and cognitive-motor interaction, and benefit physical therapy and amputee rehabilitation.