Design and Evaluation of a Biarticular Prosthesis to Reduce Gait Compensations

项目摘要/摘要 我提议的研究和培训计划旨在提高退伍军人的机动性和生活质量 通过开发一种新型的双关节假体进行经胫骨截肢，并培训我 通过引导和支持进行神经肌肉生物力学、假体工程和步态模拟 一支强大的多学科导师团队，使我能够成为一名成功的独立研究人员 科学家。我的长期职业目标是设计、开发和评估新型假肢、矫形器和辅助装置。 为行动不便的人提供的设备。与这一目标一致，我建议设计、开发和 评估一种新的双关节假体，它解决了目前下肢假体的一些局限性。 在美国，大约有100万人生活在失去腿部的生活中。流动的一个重要原因 在这一人群中，损伤是指踝部足底屈肌的丧失，因为这些肌肉是主要的 在正常行走过程中，身体支撑、向前推进和摆动腿启动的贡献者。双关节 腓肠肌(GAS)具有与比目鱼肌不同的作用；它为 使腿部进入摆动阶段。如果没有气体，剩下的腿部肌肉的代偿性变化是 必要时，包括增加向心力，以加速腿部进入摆动阶段。 目前的假肢不能复制脚踝足底屈肌的生理功能。走路的时候 对于传统的足踝假体系统，TT截肢者表现出有限的推力，他们使用 自适应步态策略，例如在摆动前增加髋屈肌在假体一侧的作用力，以 弥补了双关节气体的不足。这些补偿被认为是导致收入增加的原因 截肢者行走的代谢成本。 为了减少TT截肢者的典型步态补偿，我提议开发一种新的双关节 假体(BP)，带有跨越脚踝和膝关节的紧握弹簧。BP将有能力 以产生净的正踝关节功，并提供能量来推动腿部进入挥杆状态。我会用 对TT截肢者进行肌肉骨骼建模和步态仿真，以优化BP的设计，我将使用 步态分析，评价BP对步态的影响。BP有可能减少步态补偿 并改善TT截肢退伍军人的功能活动能力。该提案有三个具体目标： 目的1：利用模拟，确定特定对象的最优BP参数。 目标2：证明TT截肢者的步态补偿通常与传统的被动- 弹性假体在一定的行走速度范围内使用特定于受试者的最佳BP来减少。 目的3：确定最佳血压是否能降低步行的代谢成本。 为了加速我的培训，促进我成为一名独立的研究科学家，我带来了 将具有不同专业知识的导师聚集在一起。Czerniecki博士是退伍军人管理局的物理学家和康复学教授 专门从事截肢者康复和步态分析的医学。Klute博士是退伍军人事务部研究职业科学家 有一个充满活力的研究项目，专注于假肢工程和截肢者的行动能力。Thelen博士是一位 机械和生物力学工程教授，步态计算模拟专家。Dr。 斯蒂尔是机械工程助理教授和OpenSim研究员，具有详细的知识或 肌肉骨骼建模。在指导下实施拟议的研究项目和培训计划 这些导师中的一位将使我成为步态、假肢等神经肌肉生物力学方面的专家 工程学和步态计算模拟，并建立一个独立的研究事业。

Project Summary / Abstract My proposed research and training program aims to improve the mobility and quality of life of veterans with transtibial (TT) amputation through the development of a novel biarticular prosthesis, and to train me in neuromuscular biomechanics, prosthetic engineering, and gait simulations through the guidance and support of a strong multidisciplinary team of mentors, so that I can become a successful independent research scientist. My long-term career goal is to design, develop and evaluate novel prosthetic, orthotic and assistive devices for people with reduced mobility. Consistent with this goal, I am proposing to design, develop and evaluate a novel biarticular prosthesis that addresses some of the limitations of current lower limb prostheses. Approximately one million people in the US are living with lower limb loss. An important cause of mobility impairment in this population is the loss of the ankle plantar flexors since these muscles are the primary contributors to body support, forward propulsion and swing leg initiation during normal walking. The biarticular gastrocnemius (GAS) has a role distinct from that of the soleus; it provides the dominant source of energy to power the leg into swing phase. Without the GAS, compensatory changes of the remaining leg muscles are necessary, including an increase in the concentric iliopsoas force to accelerate the leg into swing phase. Current prosthetic limbs cannot replicate the physiologic function of the ankle plantar flexors. When walking with conventional prosthetic foot-ankle systems, TT amputees show limited push-off power, and they use adaptive gait strategies, such as increased hip flexor work on the prosthetic side during pre-swing, to compensate for the lack of a biarticular GAS. These compensations are thought to contribute to the increased metabolic cost of amputee walking. To reduce the gait compensations typical of TT amputees, I am proposing to develop a novel biarticular prosthesis (BP) with a clutched spring that spans the ankle and knee joint. The BP will have the ability to generate net positive ankle joint work and to provide energy to power the leg into swing. I will use musculoskeletal modeling and simulations of TT amputee gait to optimize the design of the BP, and I will use gait analysis to evaluate the effect of the BP on gait. The BP has the potential to reduce gait compensations and improve functional mobility in veterans with TT amputation. The proposal has three specific aims: Aim 1: Using simulation, determine subject-specific optimal BP parameters. Aim 2: Demonstrate that the TT amputee gait compensations typically seen with conventional passive- elastic prostheses are reduced with the subject-specific optimal BP across a range of walking speeds. Aim 3: Determine if the Optimal BP reduces the metabolic cost of walking. To accelerate my training and facilitate my development into an independent research scientist, I have brought together mentors with diverse expertise. Dr. Czerniecki is a VA physiatrist and professor of rehabilitation medicine specializing in amputee rehabilitation and gait analysis. Dr. Klute is a VA research career scientist with a vibrant research program focused on prosthetic engineering and amputee mobility. Dr. Thelen is a professor of mechanical and biomechanical engineering and an expert in computational simulations of gait. Dr. Steele is an assistant professor of mechanical engineering and an OpenSim fellow with detailed knowledge or musculoskeletal modeling. Conducting the proposed research project and training program under the guidance of these mentors will allow me to become an expert in the neuromuscular biomechanics of gait, prosthetic engineering, and computational simulations of gait and to establish an independent research career.