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

项目总结/摘要 在美国，有160多万人生活在失去至少一条肢体的情况下。[1]这个数字 由于人口老龄化，预计到2050年将增加一倍以上。虽然最近的事态发展， 技术导致了复杂的假肢，这是学习假肢技能的科学基础， 肢体丧失后的活动能力恢复尚不清楚，导致截肢患者的差异很大， 在乎[2]具体来说，运动学习的原则和证据并不能指导运动学习的过程。 在这个人群中进行假肢技术培训。[3，4]下肢丧失后的活动能力恢复仍然是一个主要的问题。 这是一个巨大的挑战，特别是对于年龄较大的截肢者和患有慢性糖尿病的感觉运动障碍的人。[5-7] 在过去的20年里，越来越多的证据表明，注意力集中的方向在执行过程中， 运动任务影响运动学习的有效性。[8]具体来说，将注意力从外部引导到 与内部关注相比，运动结果一直被证明可以促进学习 肢体动作[8-10]注意力焦点的操纵在以下临床背景下具有明显的意义： 学习修复技术如果假肢运动技能的学习可以通过与外部 如果我们能集中注意力，那么肢体丧失患者的康复方式将发生巨大的变化。 这个K 01职业发展奖将有助于发展我的能力，作为一个独立的研究人员在 与截肢者康复有关的运动学习领域。我的计划目标是：1）提高我的 运动学习科学的知识，以及2）获得在患有以下疾病的人群中进行临床研究的培训 而且有截肢的危险这个计划是我临床生物力学背景的逻辑延伸， 热衷于截肢者康复的转化研究。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则的理解， 失去肢体的痛苦这将导致未来制定基于证据的截肢者康复战略。 我的家乡机构，内华达州，拉斯维加斯（UNLV）的大学，致力于推进合作 健康科学的研究和教育活动。UNLV物理治疗部目前 截肢者联盟的南内华达州团体的会议地点，我积极参与其中。 关键UNLV教师谁将在我的指导委员会服务包括罗伯特格雷戈（教授 格鲁吉亚理工学院名誉教授;联合健康科学学院研究顾问）， Gabriele Wulf（UNLV运动学与营养科学系教授）。联合国志愿人员组织外部导师 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说， 康复在弗吉尼亚州南部内华达州医疗保健系统，博士埃里克阿奎拉，已同意协助这一事业 开发和研究计划，为拟议的研究提供患者人群。 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