Measuring In-Socket Residual Limb Volume Fluctuation

描述（由申请人提供）：拟议研究的长期目标是对假肢使用者有效实施残肢体积管理策略，以提高他们的临床结局、健康和生活质量。本应用程序的重点是揭示实现这一目标所必需的知识。拟议研究的具体目的是确定不同的活动和调节策略对残肢昼夜液体体积变化的影响，以及它们如何与经胫骨截肢的个人的舒适性和性能。另一个目标是为那些被规定但选择不使用残肢体积管理策略（如更换假肢袜子层）的人创建和评估一种新的适应性解决方案。为了实现这些目标，在前一个资助周期中开发的新型多通道生物阻抗分析仪器用于评估一组经胫骨（即，膝盖以下）假肢使用者。临床结果，包括插座的舒适度，满意度和感知的流动性获得使用自我报告的措施，而百分比的时间承重和使用的调节策略进行测量与定制仪器。预期肢体体积变化与使用者满意度、舒适度和移动性负相关，并且使用体积调节策略，例如袜子添加和间歇性脱（即，移除插座）增强了这些结果。我们为需要但选择不使用容量管理策略的人介绍了一种新的管理方法，即及时释放肢体关键部位的插座压力，以增加肢体液体容量恢复。根据拟议研究的结果，这种策略预计将与袜子调节一样有效或更有效，以提高结果。所提出的应用与公共卫生的相关性是更好地理解残肢流体体积变化如何影响用户使用假体的体验、与残肢健康相关的临床重要结果以及用户在生活活动中的表现。目前，它是未知的，在残肢内的流体体积的变化发生或多少变化可以容忍，而不会产生负面影响假肢配合。在资助期之后，预计拟议的研究将扩展到临床工具， 允许从业者将肢体流体体积变化问题与其它问题（例如不适当的部件或对准）隔离。潜在地，这里描述的努力可以扩展到设备需要与人体组织牢固和紧密配合的其他领域，包括trans-fermoral假肢，上肢假肢和矫形器。

DESCRIPTION (provided by applicant): The long-term goal of the proposed research is the effective implementation of residual limb volume management strategies on prosthesis users so as to enhance their clinical outcomes, health, and quality-of- life. The focus of this application s to uncover knowledge essential to accomplishing this goal. The specific aims of the proposed research are to determine the influence of different activities and accommodation strategies on residual limb diurnal fluid volume change, and how they relate to comfort and performance of individuals with trans-tibial amputation. An additional goal is to create and evaluate a novel accommodation solution for people who are prescribed, but choose not to use, residual limb volume management strategies, such as changing prosthetic sock ply. To accomplish the aims, a novel multi-channel bioimpedance analysis instrument developed in the previous funding cycle is used to assess diurnal fluid volume changes in the residual limbs of a group of trans-tibial (i.e., below-knee) prosthesis users. Clinical outcomes, including socket comfort, satisfaction, and perceived mobility are obtained using self-report measures, while percent time weight-bearing and use of accommodation strategies are measured with custom instrumentation. It is expected that limb volume change negatively correlates with user satisfaction, comfort, and mobility, and that use of volume accommodation strategies, such as sock addition and intermittent doffing (i.e., removing the socket) enhances these outcomes. A novel management alternative we introduce for people who require, but choose not to use volume management strategies, is a timely release of socket pressures at key locations on the limb so as to augment limb fluid volume recovery. This strategy, informed by the results of the proposed research, is expected to be equally or more effective than sock accommodation towards enhancing outcomes. The relevance of the proposed application to public health is better understanding of how residual limb fluid volume changes impact users' experience with a prosthesis, clinically-important outcomes related to residual limb health, and users' performance in life activities. Currently, it is unknown where within the residual limb fluid volume changes occur or how much change can be tolerated without negatively affecting prosthetic fit. Beyond the grant period, it is anticipated the proposed research will be extended into clinical tools that allow practitioners to isolate limb fluid volume change problems from other issues such as improper componentry or alignment. Potentially, the efforts described here can be extended to other areas where devices require a secure and intimate fit with human tissues, including trans-fermoral prosthetics, upper-limb prosthetics, and orthotics.