Motor Learning in Individuals with and at risk of Lower Limb Loss: Implications for Amputee Rehabilitation

项目摘要/摘要 在美国，超过160万人生活在至少失去一条肢体的情况下。 由于人口老龄化，预计到2050年将增加一倍以上。虽然最近在 技术导致了复杂的假体，假体技能学习的科学基础和 肢体丧失后活动能力的恢复尚不清楚，导致截肢者的变化很大。 [2]具体地说，没有运动学习的原理和证据来指导 在这一人群中进行假肢技能训练。[3，4]失去肢体后活动能力的恢复仍然是主要的 尤其是对于年龄较大且患有慢性糖尿病感觉运动障碍的截肢者来说，这是一项挑战。 在过去的20年里，越来越多的证据表明，在执行 运动任务影响运动学习的有效性。[8]具体地说，将一个人的注意力从外部引导到 运动的结果一直被证明可以促进学习，而不是内部专注于 身体运动。[8-10]注意焦点的操作在临床环境中有明显的意义。 学习假肢技能。假肢运动技能的学习是否可以通过与外部医生的练习来提高 如果成为人们关注的焦点，肢体丧失患者的康复方式将发生戏剧性的变化。 K01职业发展奖将有助于发展我作为一名独立研究员的能力 与截肢者康复有关的运动学习领域。我这个计划的目标是：1)推进我的 运动学习科学方面的知识，以及2)在患有运动障碍的人群中进行临床研究方面的培训 并且有失去四肢的风险。这个计划是对我的临床生物力学背景和我的 对截肢者康复相关的翻译研究充满热情。我在这里提出的研究项目 将促进我们对运动技能获得的基本原理的理解 失去肢体的可能性。这将导致基于证据的截肢者康复战略的未来发展。 我的家乡机构，内华达大学拉斯维加斯分校(UNLV)致力于推动合作 卫生科学方面的研究和教育活动。UNLV物理治疗部目前 南内华达州截肢者联盟小组的会议地点，我积极参与其中。 将在我的指导委员会任职的UNLV主要教职员工包括Robert Gregor(教授 佐治亚理工学院荣休；UNLV联合卫生科学学院研究顾问)和 Gabriele Wulf(UNLV运动学和营养科学系教授)。UNLV外部的导师 包括Carolee Winstein(南加州大学教授)和Robert Gailey(教授， 迈阿密大学)。此外，卫生部截肢者护理诊所的医务主任 退伍军人事务部南内华达州医疗系统的康复医生埃里克·阿吉拉博士已同意帮助这一职业 开发和研究计划，为拟议的研究提供接触他的患者群体的途径。 3.

Project Summary/Abstract More than 1.6 million persons in the United States are living with the loss of at least one limb.[1] This number is projected to more than double by the year of 2050 due to the aging population. While recent developments in technology have led to sophisticated prostheses, the science underlying learning of prosthetic skills and recovery of mobility after limb loss is not well understood, resulting in large variations in amputee patient care.[2] Specifically, the principles and evidence of motor learning are not available to guide the process of prosthetic skill training in this population.[3, 4] Recovery of mobility after lower limb loss remains a major challenge especially for amputees who are older and with sensorimotor impairments from chronic diabetes.[5-7] In the last 20 years, mounting evidence demonstrated that direction of attentional focus during execution of motor tasks affects effectiveness of motor learning.[8] Specifically, directing one’s attention externally to the movement outcome has been consistently shown to promote learning, when compared to an internal focus on the body movements.[8-10] Manipulation of attentional focus has obvious implications in the clinical context of learning prosthetic skills. If prosthetic motor skill learning can be improved through practice with an external focus of attention, there would be a dramatic transformation in how patients with limb loss are rehabilitated. This K01 Career Development Award will serve to develop my abilities as an independent researcher in the field of motor learning as pertaining to amputee rehabilitation. My goals for this plan are to: 1) advance my knowledge in motor learning science, and 2) obtain training in conducting clinical research in populations with and at risk of limb loss. This plan is a logical extension of my background in clinical biomechanics and my passion for translational research pertaining to amputee rehabilitation. The research projects I propose here will advance our understanding of fundamental principles of motor skill acquisition in individuals with and at risk of limb loss. This will lead to future development of evidence-based amputee rehabilitation strategies. My home institution, the University of Nevada, Las Vegas (UNLV), is committed to advancing collaborative research and educational activities in the health sciences. UNLV Department of Physical Therapy is currently the meeting site for the Southern Nevada group of Amputee Coalition, with which I have active involvement. Key UNLV faculty members who will serve on my Mentoring Committee include Robert Gregor (Professor Emeritus, Georgia Institute of Technology; Research Consultant, UNLV School of Allied Health Sciences) and Gabriele Wulf (Professor, UNLV Department of Kinesiology and Nutrition Sciences). Mentors external to UNLV include Carolee Winstein (Professor, University of Southern California) and Robert Gailey (Professor, University of Miami). Furthermore, the Medical Director of the Amputee Care Clinic in the Department of Rehabilitation at the VA Southern Nevada Healthcare System, Dr. Eric Aguila, has agreed to assist this career development and research plan by providing access to his patient population for the proposed research studies. 3