Spinal loads during activities of daily living: Influences of unilateral lower-limb amputation

项目摘要 尽管在单侧下肢截肢者中下腰痛(LBP)的患病率较高 (乌拉)与身体健全的个体相比，人们对其基本机制知之甚少 在这种情况下。我们的研究是向研究下背部生物力学迈出的第一步 使用高级计算建模技术为未来设计有效的干预措施提供信息 伦敦金融城。具体地说，Ulla患者在表演时采用的躯干神经肌肉模式的影响 将调查脊柱负荷下的日常生活能力和脊柱组织损伤的风险。这将是 通过对大量高质量运动学数据进行二次生物力学分析实现的 有或没有Ulla的个人执行以下任务：1)自行选择和控制行走 速度，2)坐到站和站到坐，以及3)上楼梯和下楼梯。我们的中心假设是， 与健全个体相比，Ulla患者应对躯干运动的策略 日常活动的体力需求与复杂的内部肌肉力量模式有关 这会导致脊柱承受更大的负荷，脊柱组织受损的可能性也更高。我们的数据集绘制 来自沃尔特里德国家军事医学中心(WRNMMC)的生物力学实验室 史无前例地使用Ulla接触到大量的服役人员。使用这个独特的数据库，我们 将实施我们的新的有限元建模方法来估计内部肌力(即采用 神经肌肉模式)需要在满足平衡的基础上进行日常体力活动 整个腰椎的稳定性。该项目的完成将使我们能够确定 肌肉补充，以及由此对脊柱负荷的影响和脊柱组织损伤的风险， 在有乌拉和没有乌拉的人之间。因此，这一试点项目有望建立起初步的 为未来的研究奠定基础，包括设计针对躯干的高度特异性干预措施 截肢后康复中的神经肌肉行为以减少对下背部的不良影响 生物力学和LBP的潜力。

Project Summary Despite the higher prevalence of low back pain (LBP) among persons with unilateral lower limb amputation (ULLA) compared to able-bodied individuals, relatively little is known about the fundamental mechanisms underlying this condition. Our research represents a first step toward investigating lower back biomechanics using advanced computational modeling techniques to inform the future design of effective interventions for LBP. Specifically, the impact of trunk neuromuscular patterns adopted by persons with ULLA while performing activities of daily living on spinal loads and the risk of spinal tissue damage will be investigated. This will be achieved via secondary biomechanical analyses of a large set of high-quality kinematics data obtained from individuals with and without ULLA performing the following tasks: 1) walking at self-selected and controlled speeds, 2) sit-to-stand and stand-to-sit, and 3) stairs-up and stairs-down. Our central hypothesis is that, compared to able-bodied individuals, trunk movement strategies adopted by persons with ULLA to cope with physical demands of common daily activities are associated with a complex pattern of internal muscle forces that result in larger loads on the spine and a higher probability for spinal tissue damage. Our dataset draws from the Biomechanics Laboratory at Walter Reed National Military Medical Center (WRNMMC) which has unprecedented access to a large population of service members with ULLA. Using this unique database, we will implement our novel finite element modeling approach to estimate the internal muscle forces (i.e., adopted neuromuscular patterns) needed to perform daily physical activities on the basis of satisfying equilibrium and stability across the entire lumbar spine. Completion of this project will enable us to determine differences in muscle recruitment, as well as the resultant effects on spinal loads and the risk of spinal tissue damage, between persons with and without ULLA. Hence, this pilot project is expected to establish the initial groundwork for future research involving the design of highly specific interventions aimed at trunk neuromuscular behaviors during post-amputation rehabilitation to lessen adverse effects on lower back biomechanics and the potential for LBP.