在下肢假肢设计优化中考虑被动机械性能和患者使用者的运动表现，以提高康复效果。
Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes.
作者信息
Major Matthew J, Fey Nicholas P
机构信息
Jesse Brown VA Medical Center, Chicago IL, USA.
Northwestern University Prosthetics Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago IL, USA.
出版信息
Phys Ther Rev. 2017 Jul 17;22(3-4):1-15. doi: 10.1080/10833196.2017.1346033.
BACKGROUND
Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention.
OBJECTIVES
This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes.
MAJOR FINDINGS
Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization.
CONCLUSIONS
By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.
背景
选择具有特定机械特性的假肢以恢复下肢缺失者的功能，可被视为一个优化问题，旨在满足特定的性能目标。然而，特定目标的选择至关重要，仅考虑假肢装置以及适用于所有用户的普遍结果，而不考虑个体固有的运动表现，可能会使特定患者无法充分实现假肢干预的益处。
目的
本综述介绍了优化被动式膝下假肢设计以最大化康复效果的方法，以及考虑患者运动表现如何能提升这些效果。
主要发现
现有文献表明，考虑与运动表现相关的患者特定变量，能构建一个将假肢装置特性与用户功能联系起来的多维框架，这可能为个体患者的康复效果提供更准确的预测。此外，增加有针对性的物理治疗干预以促进用户自我组织，可能会进一步改善这些效果。我们指出了现有模式在解决这些额外维度方面的潜力，并鼓励研究人员考虑用于假肢优化的众多不同性能目标。
结论
通过结合用户运动表现和假肢机械特性来考虑，可以制定一种分阶段的优化方法，该方法承认假肢装置的改进可能仅在一定程度上改善效果，而用户自我组织是完全康复的关键组成部分。一个可整合到现有康复实践中的迭代过程，通过联合有针对性的假肢解决方案和物理治疗技术，考虑了患者状态的变化，并体现了对下肢缺失患者进行个性化干预的理念。
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