Optimizing Prosthetic and Bicycle Fit for Veterans with Transtibial Amputations

在美国，有超过一百万人截肢，这个数字还在继续增长， 糖尿病的流行和最近的军事冲突。由于一个由一个 截肢，推进康复，优化假肢的使用， 截肢的退伍军人可以恢复最大可能的健康水平，功能和身体活动。 [低影响运动，如骑自行车，可以促进截肢后重返工作/岗位， 经胫骨截肢退伍军人的心血管健康、肌肉力量、耐力和生活质量 （TTA）。骑自行车作为锻炼还可以防止血管疾病和糖尿病的有害影响， 改善心血管功能，控制体重，降低再次截肢率， 生活质量与TTA的退伍军人。然而，很可能是不适和增加的潜在风险， 由于缺乏适当的假肢/自行车配合而导致的继发性肌肉骨骼损伤阻碍了患有TTA的退伍军人 使用自行车进行康复和锻炼。此外，目前还不清楚假肢和自行车 组件，例如外挂架长度（PL）、假肢前足下方的踏板连接位置（PAP 和曲柄臂长度（CAL）影响生物力学、代谢成本和舒适度。 退伍军人对TTA的满意度。因此，我们的目标是通过开发 基于证据的假肢和自行车适配指南，优化生物力学，代谢成本，效率 （机械功率/代谢功率）和舒适度/满意度。部 退伍军人事务部（VA）和国防部（DoD）康复指令提出了一项倡议， 旨在大大改善和恢复受伤的退伍军人和服务人员的功能， 可以选择重返现役或从事生产性文职工作。我们提出的研究将建立 最佳的假肢/自行车适配指南，这将通过改善心血管健康来增强功能， 控制体重，降低再次截肢率，提高TTA退伍军人的生活质量， 从而有助于实现这一倡议并具有很高的潜在影响。具体而言，我们的目标是：1）研究15 患有单侧TTA的退伍军人，以确定系统性变化的PL，PAP的影响。 假肢前足与假肢假肢，以及CAL对患腿的自行车生物力学，代谢成本， 舒适/满足。2)将我们的研究结果综合并传播到实用的、基于证据的定量研究中， 适用于TTA退伍军人的假肢/自行车适配指南。我们假设，较长的PL和较短的CAL 受影响的腿与未受影响的腿相比，沿着， 前脚将最大限度地提高机械功率对称性，并减少代谢成本和肌肉活动， 最大限度地提高效率和舒适度/满意度在骑自行车的退伍军人与单边TTA。[The利用 以证据为基础的假肢/自行车适合指南，增加对称性，提高舒适度，降低风险， 受伤，降低代谢成本，提高效率，将直接受益于TTA退伍军人， 身体活动和功能）。优化的假肢/自行车适配指南将允许退伍军人TTA， 以前不能舒适地骑自行车，以及那些目前骑自行车，骑更长的时间， 更少的努力和不适，潜在地导致生活质量的改善。而且 这项研究产生的假肢/自行车适配指南将确保临床医生能够适配退伍军人 与TTA自行车更有效地，导致更短的预约时间和更少的重访，由于 增强功能和减少合并症。

Over one million people in the United States have a leg amputation and this number continues to grow due to the prevalence of diabetes and recent military conflicts. Because of the functional impairment caused by an amputation, it is extremely important to advance rehabilitation that optimizes the use of prostheses so that Veterans with amputations can regain the greatest possible level of health, function, and physical activity. [Low-impact exercise such as bicycling could facilitate return to work/duty after amputation by improving cardiovascular fitness, muscle strength, endurance, and quality of life for Veterans with transtibial amputations (TTAs). Bicycling as exercise could also prevent the deleterious effects of vascular disease and diabetes by improving cardiovascular function, controlling body weight, decreasing the rate of re-amputation, and improving quality of life for Veterans with TTAs. However, it is likely that discomfort and the increased potential for secondary musculoskeletal injury due to the lack of a proper prosthetic/bike fit discourages Veterans with TTAs from using bicycling for rehabilitation and exercise. Moreover, it is unclear how prosthetic and bicycle components, such as pylon length (PL), pedal attachment position (PAP) beneath the prosthetic forefoot versus the pylon, and crank arm length (CAL) affect the biomechanics, metabolic costs, and comfort/ satisfaction of Veterans with TTAs. Thus, our goal is to challenge the state-of-the-science by developing evidence-based prosthetic and bicycle fit guidelines that optimize the biomechanics, metabolic costs, efficiency (mechanical power/metabolic power) and comfort/satisfaction for Veterans with TTAs.] The Department of Veterans Affairs (VA) and Department of Defense (DoD) Rehabilitation Directive has put forth an initiative that aims to dramatically improve and restore function in wounded Veterans and Service members so that they have the choice to return to active duty or productive civilian employment. Our proposed research will establish optimal prosthetic/bicycle fit guidelines, which would enhance function by improving cardiovascular health, controlling body weight, decreasing re-amputation rates, and enhancing quality of life of Veterans with TTAs, thus helping to fulfill this initiative and having high potential impact. Specifically, we aim to: 1) Study 15 Veterans with unilateral TTAs to determine the effects of systematically varying PL, PAP beneath the prosthetic forefoot versus the pylon, and CAL for the affected leg on bicycling biomechanics, metabolic costs, and comfort/satisfaction. 2) Synthesize and disseminate our findings into practical, evidence-based quantitative prosthetic/bicycle fit guidelines for Veterans with TTAs. We hypothesize that a longer PL and shorter CAL for the affected compared to the unaffected leg along with a PAP beneath the pylon compared to beneath the forefoot will maximize mechanical power symmetry and reduce metabolic cost and muscle activity, and thus maximize efficiency and comfort/satisfaction during bicycling in Veterans with unilateral TTAs. [The utilization of evidence-based prosthetic/bicycle fit guidelines that increase symmetry, improve comfort, reduce the risk of injury, decrease metabolic costs, and improve efficiency will directly benefit Veterans with TTAs by increasing their physical activity and function.] Optimized prosthetic/bicycle fit guidelines will allow Veterans TTAs who were previously unable to comfortably ride a bicycle, as well as those currently riding a bicycle, to ride longer with less effort and discomfort, potentially leading to an improved quality of life. Moreover, the prosthetic/bicycle fit guidelines generated by this research will ensure that clinicians are able to fit Veterans with TTAs to bicycles more effectively, leading to shorter appointment times and fewer revisits due to enhanced function and reduced comorbidities.