MECHANICALLY INDUCED STOCHASTIC RESONANCE TO IMPROVE AMPUTEE GAIT AND BALANCE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 目的：糖尿病的众多并发症之一是足部感觉丧失。这种感觉缺陷会对非截肢者的姿势稳定性和灵活性产生负面影响，因为如果没有反馈，站立和行走就会更加困难。对于下肢截肢者来说，这个问题更加复杂。这些患者在机动任务中经常难以放置假肢，安静站立时他们的压力中心运动显著增加，临床和观察步态分析显示他们的步态模式与非截肢者相比发生了显著变化。 我们的工作建议探索一种新的假体介入治疗糖尿病下肢截肢者。我们假设我们的干预将充分增强本体感觉，从而显著改善这些患者的姿势稳定性和运动功能。这种干预是基于一种称为随机共振的现象，在这种现象下，亚阈值振动的应用使以前无法对刺激做出反应的机械感受器变得更容易受到去极化。对于神经病理性本体感觉丧失的人，随机共振可能会促进以前需要粗略输入的细微刺激的功能反应。 这项研究的目的是发现残肢表面的机械随机共振是否会改善糖尿病经胫骨截肢者的姿势稳定性和灵活性。 研究计划：我们建议招募糖尿病经胫骨截肢患者佩戴专门制造的研究假体插座，以使用微型振动马达产生随机共振。为了衡量干预对姿势稳定性的影响，我们将进行一项量化的电脑摇摆实验，并采用一项额外的测试来测量典型日常活动中的平衡(Berg平衡量表)。为了测量对运动功能的影响，我们将进行临床仪器化步态分析和测量动态平衡和功能(扩展定时起床和围棋)的测试。 方法：本研究采用受试者内设计，通过研究膝关节以下截肢者佩戴的假肢插座，比较在使用和不使用随机共振的情况下平衡和步态的测量。一组正常的受试者也将被录取，以帮助制定礼仪。 临床意义：对于患有糖尿病神经性并发症的截肢患者，拟议的研究是朝着开发一种新的、临床上可行的方法迈出的第一步，以改善他们的活动能力，降低他们跌倒相关伤害的风险。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. OBJECTIVE: One of the many complications of diabetes is the loss of sensation in the feet. This sensory deficit can negatively impact the postural stability and mobility of non-amputees, since without feedback, it is simply more difficult to stand and walk. For lower limb amputees, the problem is compounded. These patients often have difficulty with prosthetic limb placement during maneuvering tasks, exhibit dramatic increases in the movement of their center of pressure during quiet standing, and both clinical and observational gait analysis reveal significant changes in their gait pattern relative to non-amputees. Our work proposes to explore the use of a novel prosthetic intervention for diabetic lower limb amputees. We hypothesize that our intervention will sufficiently enhance proprioception to result in measurably improved postural stability and locomotor function for these patients. The intervention is based on a phenomenon known as stochastic resonance, whereby the application of sub-threshold vibration enables mechano-receptors previously unable to respond to stimuli to become more susceptible to depolarization. For persons with neuropathic proprioceptive losses, stochastic resonance may facilitate a functional response from subtle stimuli where gross inputs were formerly required. The objective of the proposed research is to discover if machanical stochastic resonance of the surface of the residual limb will improve the postural stability and mobility of diabetic transtibial amputees. RESEARCH PLAN: We propose to recruit diabetic transtibial amputees to wear a study prosthetic socket which has been specially built to produce stochastic resonance using miniature vibratory motors. To measure the intervention effect on postural stability, we will conduct a quantitative computerized sway experiment and employ an additional test that measures balance during representative daily activities (Berg Balance Scale). To measure the effect on locomotor function, we will conduct a clinical instrumented gait analysis and a test that measures dynamic balance and function (Expanded Timed Get-up and Go). METHODS: The proposed study is a within-subject design where we will compare measures of balance and gait with and without the application of stochastic resonance through a study prosthetic socket worn by the below-knee amputee. A group of normal subjects will be enrolled as well to aid in protocol development. CLINICAL RELEVANCE: For lower limb amputees with neuropathic complications from diabetes, the proposed research is the first step toward developing a new and clinically feasible approach to improving their mobility and reduding their risk of fall-related injuries.