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

项目摘要 跌倒和对跌倒的恐惧在下肢截肢（LLA）患者中很普遍， 在全国人口增长。LLA患者的福尔斯发生率经常被报道， 需要调整姿势的活动。转移（例如，坐立）和涉及动态平衡的活动 控制（例如，达到和转动）导致许多血管障碍的经胫骨截肢者的福尔斯跌倒。这一证据 强调迫切需要解决平衡和姿势稳定性问题，以确保有效的日常生活活动， 个人与LA。 目前的假肢技术不允许截肢者使用者在截肢时应用典型的姿势控制策略。 假体关节，限制姿势稳定性并产生额外的健康问题。相反，截肢者往往 发展代偿策略，用剩余的（未截肢的）关节和完整的肢体来控制平衡。的 主动自由度的损失（例如，踝和/或膝）的损伤显著地限制了生物力学 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可以解决以下需求： 改善了LLA患者的平衡和姿势稳定性;然而，相关研究强调， 有效和舒适的行走，而不是平衡和姿势控制。作为平衡和姿势控制 几乎所有活动都是在直立位置进行的，使用假肢技术直接解决 截肢者的平衡稳定性是非常需要的，但在我们的领域很少研究。 本研究的目的是探讨直接肌电图（dEMG）训练的效果 动力假肢踝关节对经胫骨截肢者（目标1）平衡和姿势稳定性（目标2）的控制 神经肌肉控制和协调，以及（目标3）认知过程，与每日规定的被动 装置. 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 在患有LLA的个体中稳定。使用dEMG控制的动力假体为用户提供了额外的 资源，以协助平衡稳定性和提高平衡的信心，这反过来又提高了他们的 社区参与和生活质量。与此同时，拟议项目预计将有助于 对假肢技术领域的重要知识，对运动领域的科学贡献 控制和学习，生物力学和认知运动相互作用，并有利于物理治疗和截肢者 康复活动.

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.