How persons with transtibial amputation regulate lateral stepping while walking in laterally destabilizing environments.
How persons with transtibial amputation regulate lateral stepping while walking in laterally destabilizing environments.
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DOI：
10.1016/j.gaitpost.2020.09.031
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发表时间：
2021-01
期刊：
影响因子：
2.4
通讯作者：
Wilken JM
中科院分区：
文献类型：
--
作者：
Dingwell JB;Cusumano JP;Rylander JH;Wilken JM
下肢截肢患者通常会出现体能下降、行走困难和跌倒风险增加。为了防止失去平衡或从失去平衡中恢复过来，必须有效地调节他们的脚步动作。因此，关键是要确定截肢者如何调节步进。在这里，我们使用了一个多目标控制框架的基础上目标等效流形，以确定如何与经胫骨截肢（TTA）的人调节横向步进，而步行没有和有横向扰动。当在不稳定的环境中行走时，TTA的健康人是否由于控制能力受损而表现出更大的调节横向步进的困难？或者，尽管他们被截肢了，他们还是继续使用类似的策略来调节横向行走吗？八个人与单侧TTA和13健全（AB）的控制走在虚拟环境中的三种条件下：无扰动，横向振荡的视野，和横向振荡的跑步机平台。我们分析了步宽和绝对横向身体位置的一步一步的时间序列。我们计算了每个时间序列的平均值、标准差和去趋势波动分析指数，并计算了参与者在每一步直接纠正了多少步宽和位置偏差。我们将我们的结果与计算预测进行了比较，以确定我们实验发现的根本原因。所有参与者表现出显着增加的变异性，降低标度指数，更严格的直接控制时，扰动。从我们的步进调节模型的模拟显示，人们对增加的变化所产生的施加的扰动收紧他们的控制的步宽和横向位置。与TTA的参与者表现出只有几个微小的差异，从AB在横向步进调节，即使受到实质上不稳定的横向扰动。由于控制步进本质上是多目标的，制定有效的干预措施，以减少截肢者的跌倒风险，可能需要采取本质上多目标的方法的战略。
Persons with lower limb amputation often experience decreased physical capacity, difficulty walking, and increased fall risk. To either prevent or recover from a loss of balance, one must effectively regulate their stepping movements. It is therefore critical to identify how well persons with amputation regulate stepping. Here, we used a multi-objective control framework based on Goal Equivalent Manifolds to identify how persons with transtibial amputation (TTA) regulate lateral stepping while walking without and with lateral perturbations. When walking in destabilizing environments, do otherwise healthy persons with TTA exhibit greater difficulty regulating lateral stepping due to impaired control? Or do they continue to use similar strategies to regulate lateral stepping despite their amputation? Eight persons with unilateral TTA and thirteen able-bodied (AB) controls walked in a virtual environment under three conditions: no perturbations, laterally oscillating visual field, and laterally oscillating treadmill platform. We analyzed step-to-step time series of step widths and absolute lateral body positions. We computed means, standard deviations and Detrended Fluctuation Analysis exponents for each time series and computed how much participants directly corrected step width and position deviations at each step. We compared our results to computational predictions to identify the underlying causes of our experimental findings. All participants exhibited significantly increased variability, decreased scaling exponents, and tighter direct control when perturbed. Simulations from our stepping regulation models revealed that people responded to the increased variability produced by the imposed perturbations by tightening their control of both step width and lateral position. Participants with TTA exhibited only a few minor differences from AB in lateral stepping regulation, even when subjected to substantially destabilizing lateral perturbations. Since control of stepping is intrinsically multi-objective, developing effective interventions to reduce fall risk in persons with amputation will likely require strategies that adopt intrinsically multi-objective approaches.
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