Skin Temperature Perception and Prosthetic Thermoregulation

描述(由申请人提供)： 项目摘要：下肢截肢者经常抱怨皮肤温度不舒服，以及假体内的汗液堆积。散步等活动会导致皮肤温度大幅上升，因此，即使在休息时间比活动时间更长的情况下，额外的活动也会导致典型一天中皮肤温度的累积上升。其中一个原因是，用来制作假体的材料是非常有效的绝缘体，不透湿；在假体内吸收热量并积聚汗水。截肢者的体温调节可能会因神经元退化、温度感觉和血管运动反应受损而进一步复杂化。为了解决这一重要的资深截肢者问题，我们已经建立了一种新的仪器，可以同时测量皮肤温度感知阈值和对不断变化的皮肤温度条件的体温调节反应。我们还制造了一种独特的保暖假人，用它我们可以优化原型假肢的设计，旨在提供散热和排出积汗。我们提出的研究将使用该仪器和暖体假人来实现三个具体目标。具体目标1将确定对热刺激的感知阈值，以及是否存在任何与截肢或糖尿病相关的体温调节障碍。我们将使用一种新的仪器来研究皮肤温度变化对健康非截肢者(n=20)、创伤原因截肢者(n=20)和糖尿病截肢者(n=20)的影响。这台仪器将使我们能够测量受试者能够感知温暖和寒冷刺激的皮肤温度。同时，我们还将测量局部血流的变化，这是一项重要的体温调节策略。这项实验的数据将使假设检验能够区分特定人群的差异。《特殊目的2》将使用一种独特的散热假人来优化设计一种新型的动态空气交换假体，该假体旨在提供散热和排出积汗。我们已经建造了这种假体的原型，并在初步的人体实验中观察到了有希望的结果。为了便于设计改进，我们建立了一个保暖人体模型来物理模拟残肢。我们计划在台式实验中使用这个实验模型来优化我们的新型假体的流入端口、压差和控制器操作的位置和数量。特定目标3将确定我们优化的动态空气交换假体是否能够保持比当前护理标准更低、更舒适的皮肤温度和减少出汗，这是一种带有远端锁定销悬挂的假体。我们将进行一项包括创伤性(n=10)和糖尿病(n=10)下肢截肢患者在内的受试者内比较测试。这项实验的数据将使假设检验能够直接比较两种假体在皮肤温度、汗水和热舒适性方面的差异。这项拟议的研究将提供对截肢者群体的热感觉和生理反应的透彻了解，并提供旨在提供热缓解的新型假体与为许多下肢截肢者开出的假体之间的直接比较。这项拟议研究产生的循证理解和假肢技术创新有望显著改善下肢截肢者的生活体验。

DESCRIPTION (provided by applicant): PROJECT SUMMARY Lower limb amputees often complain about uncomfortable skin temperatures and the accumulation of perspiration within their prostheses. Activities, such as walking, cause substantial increases in skin temperatures such that additional bouts of activity, even when interspersed with rest periods longer than the activity periods, result in a cumulative increase in skin temperature through the course of a typical day. One reason is that the materials from which their prostheses are constructed are extremely effective insulators and impermeable to moisture; trapping heat and accumulating sweat inside the prosthesis. Amputee thermoregulation may be further complicated by neuronal degradation impairing temperature sensation and vasomotor response. To address this important Veteran amputee issue, we have already built a novel instrument to simultaneously measure skin temperature perception thresholds and thermoregulatory responses to changing skin temperature conditions. We have also built a unique thermal manikin with which we can optimize the design of a prototype prosthesis intended to provide thermal relief and expel accumulated sweat. Our proposed research will use this instrument and thermal manikin to accomplish three specific aims. Specific Aim 1 will identify perception thresholds to thermal stimuli and the existence of any amputation- or diabetic-related thermoregulatory impairment. We will use a novel instrument to study the effect of changing skin temperature on healthy non-amputees (n=20), lower limb amputees of traumatic etiology (n=20), and lower limb amputees of diabetic etiology (n=20). This instrument will enable us to measure the skin temperatures at which participants can perceive warm and cold stimuli. At the same time, we will also measure changes in local blood flow; an important thermoregulatory strategy. Data from this experiment will enable hypothesis testing to distinguish population-specific differences. Specific Aim 2 will use a unique thermal manikin to optimize the design of a novel, dynamic air exchange prosthesis intended to provide thermal relief and expel accumulated sweat. We have already built a prototype of this prosthesis and observed promising results in our preliminary human subject experiments. To facilitate design improvements we built a thermal manikin to physically simulate the residual lower limb. We plan to use this experimental model in bench-top experiments to optimize the location and number of inflow ports, pressure differentials, and the controller operation of our novel prosthesis. Specifi Aim 3 will determine if our optimized, dynamic air exchange prosthesis can maintain lower, more comfortable skin temperatures and reduce sweating than the current standard of care, a prosthesis with a distal locking pin suspension. We will conduct a within-subject comparison test involving the participation of traumatic (n=10) and diabetic (n=10) lower limb amputees. Data from this experiment will enable hypothesis testing to directly compare the two prostheses in terms of skin temperature, sweat, and thermal comfort. The proposed research will provide a thorough understanding of thermal perception and physiologic response in the amputee population and provide for a direct comparison between a novel prosthesis intended to provide thermal relief and a prosthesis prescribed to many lower limb amputees. The evidence-based understanding and prosthetic technology innovations resulting from the proposed research are expected to measurably improve the life experiences of lower limb amputees.