Measuring In-Socket Residual Limb Volume Fluctuation

描述（由申请人提供）：本研究的长期目标是对义肢使用者有效实施残肢体积管理策略，以改善其临床结果、健康和生活质量。这个应用程序的重点是揭示实现这一目标所必需的知识。拟议研究的具体目的是确定不同活动和调节策略对残肢日体液量变化的影响，以及它们与胫骨截肢患者的舒适度和表现之间的关系。另一个目标是为那些被规定但选择不使用残肢体积管理策略的人创造和评估一种新的调节解决方案，例如改变假肢袜子的厚度。为了实现这一目标，在上一个资助周期中开发的一种新型多通道生物阻抗分析仪器被用于评估一组经胫骨（即膝盖以下）假体使用者残肢的日体液量变化。临床结果，包括眼窝舒适度、满意度和感知的活动能力，通过自我报告测量获得，而负重时间百分比和调节策略的使用则通过定制仪器测量。预计肢体体积变化与用户满意度、舒适度和活动性呈负相关，并且使用体积调节策略，如穿袜子和间歇脱绒（即取下套窝）可以增强这些结果。我们为那些需要但选择不使用容积管理策略的人介绍一种新颖的管理替代方案，即及时释放肢体关键部位的眼窝压力，以增加肢体体液的恢复。根据拟议的研究结果，预计这一战略在促进成果方面将与短期调整同等或更有效。拟议的应用与公共卫生的相关性是更好地了解残肢液量变化如何影响用户使用假肢的体验、与残肢健康相关的临床重要结果以及用户在生活活动中的表现。目前，尚不清楚残肢内的体液容量变化发生在何处，也不清楚在不影响假肢贴合的情况下可以容忍多大程度的变化。在资助期之后，预计拟议的研究将扩展到临床工具

DESCRIPTION (provided by applicant): The long-term goal of the proposed research is the effective implementation of residual limb volume management strategies on prosthesis users so as to enhance their clinical outcomes, health, and quality-of- life. The focus of this application s to uncover knowledge essential to accomplishing this goal. The specific aims of the proposed research are to determine the influence of different activities and accommodation strategies on residual limb diurnal fluid volume change, and how they relate to comfort and performance of individuals with trans-tibial amputation. An additional goal is to create and evaluate a novel accommodation solution for people who are prescribed, but choose not to use, residual limb volume management strategies, such as changing prosthetic sock ply. To accomplish the aims, a novel multi-channel bioimpedance analysis instrument developed in the previous funding cycle is used to assess diurnal fluid volume changes in the residual limbs of a group of trans-tibial (i.e., below-knee) prosthesis users. Clinical outcomes, including socket comfort, satisfaction, and perceived mobility are obtained using self-report measures, while percent time weight-bearing and use of accommodation strategies are measured with custom instrumentation. It is expected that limb volume change negatively correlates with user satisfaction, comfort, and mobility, and that use of volume accommodation strategies, such as sock addition and intermittent doffing (i.e., removing the socket) enhances these outcomes. A novel management alternative we introduce for people who require, but choose not to use volume management strategies, is a timely release of socket pressures at key locations on the limb so as to augment limb fluid volume recovery. This strategy, informed by the results of the proposed research, is expected to be equally or more effective than sock accommodation towards enhancing outcomes. The relevance of the proposed application to public health is better understanding of how residual limb fluid volume changes impact users' experience with a prosthesis, clinically-important outcomes related to residual limb health, and users' performance in life activities. Currently, it is unknown where within the residual limb fluid volume changes occur or how much change can be tolerated without negatively affecting prosthetic fit. Beyond the grant period, it is anticipated the proposed research will be extended into clinical tools that allow practitioners to isolate limb fluid volume change problems from other issues such as improper componentry or alignment. Potentially, the efforts described here can be extended to other areas where devices require a secure and intimate fit with human tissues, including trans-fermoral prosthetics, upper-limb prosthetics, and orthotics.