REMOTE PRESSURE MONITORING IN BK DIABETIC AMPUTEES

这项研究将测量机械载荷条件， 糖尿病截肢患者装药后的软组织病理变化 他们的第一个膝盖以下的永久性假肢。 我们的前期工作 已经建立了一种非侵入性的方法来监测皮肤对 延长负荷，使用组织反射光谱法（TRS）。 我们有 广泛表征了脊髓缺血后的反应 受伤和多发性硬化症的受试者，并将在这项研究中， 糖尿病截肢者的测量。 我们目前的工作也 证明了一种有效的方法， 皮肤色素沉着的主要测量参数-浅表 皮肤血液含量和氧合。 这些参数现在可以 在黑人受试者和其他族裔群体中进行了准确测量。 第一 两年将集中于收集缺血后的标准TRS 糖尿病截肢者在已知残肢部位的反应数据 处于危险之中 重复与长期负荷的影响，以及 还将对比载荷的幅度。 在此期间，TRS将 也可用于动态表征血液含量， 在我们诊所就诊的BK截肢者的氧合状态 局部疼痛和/或持续皮肤发红。 调查人员已 也有助于先进压力的发展和评估 用于临床座位和定位应用的映射技术。 在头两年，我们将进一步开发这项技术， 在日常使用过程中测量残肢-接受腔界面压力 假肢 与Tekscan Inc.合作，修改 现有技术将在第1年和第3年进行， 界面压力监测。 在第3-5年，我们将研究组织 对100多名BK糖尿病截肢者的负荷史的反应 社区，在装修后的一段时间内， 患者的第一个永久性假体。 试装后四天， TRS将用于评估残肢的区域， 表现出局部损伤、炎症或疼痛， 将测量不良反应。 详细的装载历史， 继续从收集的数据中提取组织反应 在监测期间。 表征加载历史的参数 将包括：加载重复次数; 峰值负荷;行走持续时间;摆动期间的峰值压力 阶段和相关临床数据。

This study will measure the mechanical loading conditions that proceed pathological changes in soft tissues of diabetic amputees being fitted with their first below knee, permanent prosthesis. Our preliminary work has established a non-invasive method for monitoring skin response to prolonged loading, using tissue reflectance spectrometry (TRS). We have extensively characterized the post ischemia responses of spinal cord injured and multiple sclerosis subjects and will extend in this study the measurements to diabetic amputees. Our current work has also demonstrated an effective method for accommodating for the effects of skin pigmentation on the primary measurement parameters - superficial skin blood content and oxygenation. These parameters can now be accurately measured in black subjects and other ethnic groups. The first two years will concentrate on collecting normative TRS post ischemia response data on diabetic amputees at sites on the residual limb known to be at risk. The effect of repetitive vs prolonged loading, and amplitude of loading will also be contrasted. During this time TRS will also be used to dynamically characterize the blood content and oxygenation status of BK amputees who present at our clinic with localized pain and/or persistent skin redness. The investigators have also contributed to the development and evaluation of advanced pressure mapping technology for clinical seating and positioning applications. In the first two years we will further develop this technology for measurement of stump-socket interface pressures during everyday use of the prosthesis. In collaboration with Tekscan Inc., modifications to existing technology will be made in Years 1 and 3 to permit ambulatory monitoring of interface pressures. In years 3-5 we will study tissue response to loading history for over 100 BK diabetic amputees in the community, during the period immediately after the fitting of the patient's first permanent prosthesis. Four days after the fitting, the TRS will be used to evaluate areas of the residual limb that normally exhibit localized damage, inflammation or pain and the extent of any adverse responses will be measured. The detailed loading history that proceeded the tissue response will be extracted from the data collected during the monitoring period. Parameters to characterize loading history will include: number of loading repetitions; magnitude and duration of peak loads; duration of walking sessions; peak pressures during swing phase and pertinent clinical data.