Skin Temperature Perception and Prosthetic Thermoregulation

描述（由申请人提供）： 下肢截肢者经常抱怨不舒服的皮肤温度和汗水在他们的假体内的积累。活动，例如行走，导致皮肤温度的显著增加，使得额外的活动回合，即使在穿插有比活动时段更长的休息时段时，也导致在典型的一天的过程中皮肤温度的累积增加。其中一个原因是，他们的假肢是由材料构成的，是非常有效的绝缘体和不透水的水分;捕获热量和积累汗水内的假肢。截肢者的体温调节可能会因神经元退化而进一步复杂化，从而损害温度感觉和血管反应。为了解决这个重要的退伍军人截肢者问题，我们已经建立了一个新的仪器，同时测量皮肤温度感知阈值和温度调节反应，以改变皮肤温度条件。我们还建立了一个独特的热假人，我们可以优化设计的原型假体旨在提供热救济和驱逐积累的汗水。我们的研究将使用该仪器和暖体假人来实现三个具体目标。具体目标1将确定对热刺激的感知阈值以及是否存在任何截肢或糖尿病相关的体温调节障碍。我们将使用一种新的仪器来研究改变皮肤温度对健康非截肢者（n=20）、创伤性下肢截肢者（n=20）和糖尿病性下肢截肢者（n=20）的影响。该仪器将使我们能够测量参与者能够感知温暖和寒冷刺激的皮肤温度。同时，我们还将测量局部血流的变化;这是一种重要的体温调节策略。来自该实验的数据将使假设检验能够区分群体特异性差异。Specific Aim 2将使用独特的暖体假人来优化新型动态空气交换假体的设计，该假体旨在提供热释放并排出积聚的汗液。我们已经建立了这种假肢的原型，并在我们初步的人体实验中观察到了有希望的结果。为了便于设计改进，我们建立了一个热假人物理模拟下肢残端。我们计划在台式实验中使用该实验模型来优化流入端口的位置和数量、压差以及我们的新型假体的控制器操作。Specifi Aim 3将确定我们优化的动态空气交换假体是否可以保持更低，更舒适的皮肤温度，并减少出汗，而不是目前的护理标准，一种远端锁定销悬挂的假体。我们将进行一项受试者内比较试验，涉及创伤性（n=10）和糖尿病（n=10）下肢截肢者。该实验的数据将使假设检验能够直接比较两种假体的皮肤温度、汗液和热舒适性。拟议的研究将提供一个全面的了解截肢人群的热感知和生理反应，并提供一个新的假肢旨在提供热救济和假肢规定许多下肢截肢者之间的直接比较。基于证据的理解和拟议研究所产生的假肢技术创新有望显著改善下肢截肢者的生活体验。

DESCRIPTION (provided by applicant): PROJECT SUMMARY Lower limb amputees often complain about uncomfortable skin temperatures and the accumulation of perspiration within their prostheses. Activities, such as walking, cause substantial increases in skin temperatures such that additional bouts of activity, even when interspersed with rest periods longer than the activity periods, result in a cumulative increase in skin temperature through the course of a typical day. One reason is that the materials from which their prostheses are constructed are extremely effective insulators and impermeable to moisture; trapping heat and accumulating sweat inside the prosthesis. Amputee thermoregulation may be further complicated by neuronal degradation impairing temperature sensation and vasomotor response. To address this important Veteran amputee issue, we have already built a novel instrument to simultaneously measure skin temperature perception thresholds and thermoregulatory responses to changing skin temperature conditions. We have also built a unique thermal manikin with which we can optimize the design of a prototype prosthesis intended to provide thermal relief and expel accumulated sweat. Our proposed research will use this instrument and thermal manikin to accomplish three specific aims. Specific Aim 1 will identify perception thresholds to thermal stimuli and the existence of any amputation- or diabetic-related thermoregulatory impairment. We will use a novel instrument to study the effect of changing skin temperature on healthy non-amputees (n=20), lower limb amputees of traumatic etiology (n=20), and lower limb amputees of diabetic etiology (n=20). This instrument will enable us to measure the skin temperatures at which participants can perceive warm and cold stimuli. At the same time, we will also measure changes in local blood flow; an important thermoregulatory strategy. Data from this experiment will enable hypothesis testing to distinguish population-specific differences. Specific Aim 2 will use a unique thermal manikin to optimize the design of a novel, dynamic air exchange prosthesis intended to provide thermal relief and expel accumulated sweat. We have already built a prototype of this prosthesis and observed promising results in our preliminary human subject experiments. To facilitate design improvements we built a thermal manikin to physically simulate the residual lower limb. We plan to use this experimental model in bench-top experiments to optimize the location and number of inflow ports, pressure differentials, and the controller operation of our novel prosthesis. Specifi Aim 3 will determine if our optimized, dynamic air exchange prosthesis can maintain lower, more comfortable skin temperatures and reduce sweating than the current standard of care, a prosthesis with a distal locking pin suspension. We will conduct a within-subject comparison test involving the participation of traumatic (n=10) and diabetic (n=10) lower limb amputees. Data from this experiment will enable hypothesis testing to directly compare the two prostheses in terms of skin temperature, sweat, and thermal comfort. The proposed research will provide a thorough understanding of thermal perception and physiologic response in the amputee population and provide for a direct comparison between a novel prosthesis intended to provide thermal relief and a prosthesis prescribed to many lower limb amputees. The evidence-based understanding and prosthetic technology innovations resulting from the proposed research are expected to measurably improve the life experiences of lower limb amputees.