Alt Ekstremite Amputelerinde Kaybedilen Duyusal Geribildirimlerin Giyilebilir ve İmplant Edilebilir Sensörlerle Yeniden Sağlanmasının Oluşturduğu İyileştirmeler ve Kazanımlar: Derleme Makale

Yıl 2024, Sayı: 3, 30 - 36, 30.09.2024

Cem Samut

https://doi.org/10.69563/hititsaglikderg.1499590

Öz

Amaç: Bu derleme, alt ekstremite amputasyonlarına bağlı olarak ortaya çıkan duyusal geribildirim eksikliği, protez kullanıcılarında giyilebilir veya implant edilebilir sensörler ile giderildiğinde oluşan iyileştirmeleri ve kazanımları belirlemek amacıyla yapılmıştır.
Yöntem: Alt ekstremite ampütasyonuna bağlı protez kullanıcılarında duyusal geribildirim sağlayan uygulamalar sonucundaki kazanımları belirlemek için Science Direct, Medline/Pubmed, Google scholar, Scopus ve Cochrane veri tabanları taranmıştır. Tarama yapılırken “sensory feedback (duyusal geribildirim), wearable sensors (giyilebilir sensörler), neuroprosthesis (nöroprotez), sensory substitution (duyusal ikame) ve postural control (postural kontrol) anahtar sözcükleri kullanılmış olup güncel yaklaşımlar hakkında bilgiler verilmiştir.
Sonuçlar: Duyusal geribildirime göre uygun motor yanıt oluşturması beklenen merkezi yapı yanlış veya yetersiz komutlarla alt ekstremite amputelerine postural kontrolün, yürüme hızının ve simetrisinin sağlanmasında, günlük yaşam aktivitelerinde ve egzersizlerde tüketilen enerji miktarında ve güven duygusunun korunmasında problemler çıkarmaktadır. Teknolojik cihaz ve uygulamalarla yeterli ve uygun duyusal geribildirim sağlandığında doğru motor yanıtların verilmesiyle bahsedilen problemlerin azaldığı veya ortadan kaybolduğu belirlenmiştir.
Tartışma: Protez ayağın altına yerleştirilen sensörler ile duyusal geribildirimin uyluğa aktarılmasıyla postural kontrolün iyileştiği, özellikle görsel bildirime ihtiyacın azaldığını belirtilmiştir.
Uyluk seviyesinde protez soketinin altına yerleştirilen yüzeysel deri elektrotlarını kullanarak hafif, invazif olmayan ve giyilebilir bir teknoloji olarak geliştirilen “NeuroLegs” sisteminin denendiği bir çalışmada düz zeminde artan yürüyüş simetrisi kaydedilmiştir. Eğimli ve düz yürümenin test edildiği bir araştırmada ise adım uzunluğundaki artışın ve adım genişliğindeki azalmanın duyusal geribildirimle sağlandığı tespit edilmiştir.
Giyilebilir duyusal geribildirim sağlayan sistemlerin etkisinin araştırıldığı çalışmalarda yürüyüş simetrisinin artışına bağlı olarak, yürürken güvenin artmasına ve daha az telafi edici hareketlere yol açmasıyla daha az yorgunluğa ve metabolik tüketime katkı sağladığı bulunmuştur.

Anahtar Kelimeler

Duyusal geribildirim, Giyilebilir sensörler, Nöroprotez, Postural kontrol

Improvements and Gains from Restoration of Lost Sensory Feedback in Lower Extremity Amputees with Wearable and Implantable Sensors: Review Article

Öz

Objective: This review was conducted to determine the improvements and gains that occur when the lack of sensory feedback due to lower extremity amputations is addressed with wearable or implantable sensors in prosthesis users.
Method: Science Direct, Medline/Pubmed, Google scholar, Scopus and Cochrane databases were searched to determine the gains as a result of applications providing sensory feedback in prosthesis users due to lower extremity amputation. The keywords ‘sensory feedback, wearable sensors, neuroprosthesis, neuroprosthesis, sensory substitution and postural control’ were used and information about current approaches was provided.
Results: The central structure, which is expected to generate an appropriate motor response according to sensory feedback, causes problems in providing postural control, walking speed and symmetry, the amount of energy consumed in daily life activities and exercises, and maintaining a sense of confidence in lower extremity amputees with incorrect or inadequate commands. When adequate and appropriate sensory feedback is provided with technological devices and applications, it has been determined that the mentioned problems are reduced or disappeared by giving correct motor responses.
Discussion: It has been reported that postural control is improved by transferring sensory feedback to the thigh with sensors placed under the prosthetic foot, especially reducing the need for visual feedback.
In a study in which the ‘NeuroLegs’ system, which was developed as a lightweight, non-invasive and wearable technology using superficial skin electrodes placed under the prosthesis socket at the thigh level, increased gait symmetry on flat ground was recorded. In a study testing inclined and level walking, it was found that the increase in step length and decrease in step width were provided by sensory feedback.
In studies investigating the effect of wearable sensory feedback systems, it was found that due to the increase in gait symmetry, it contributes to less fatigue and metabolic consumption by increasing confidence while walking and causing less compensatory movements.

Anahtar Kelimeler

Sensory feedback, Wearable sensors, Neuroprosthesis, Postural control

Kaynakça

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