Active Head Support for Children with Hypotonia

肌张力低下儿童的主动头部支撑

• 批准号: 1706428
• 负责人: Joshua Schultz
• 金额: $ 32.88万
• 依托单位: University of Tulsa
• 依托单位国家: 美国
• 项目类别: Continuing Grant
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1706428&HistoricalAwards=false
• 关键词: Active; Head; Support; Children; Hypotonia

Children with certain developmental disabilities often do not possess the muscle tone (or underlying muscle tension) in the neck necessary to hold their heads erect. Without external support, the head falls to the chest, to the side, or behind them. This brings about other complications, such as drooling and inability to maintain normal gaze, and inhibits the child's ability to explore the world, causing developmental delays. The current therapeutic practice is to suspend the child's head from a rigid support using a cable and head strap. This rigid suspension can only provide one passive level of support; how much it helps to hold up the head cannot be easily modified in response to the wearer's needs. While this does help eliminate some of the symptoms and complications of poor head posture, it does nothing to help the child learn to control their head by their own muscle power. It also prohibits the child from moving their head in certain directions when desired. This research brings together trained therapists and engineers who will investigate whether assisting the child to raise their head from positions where it is difficult to do so (e.g. with the head tilted far forward, back, or resting on the shoulder), and providing less assistance where it is easier for the child to support the head on their own will promote developing independent control of the head, with less need for support over time. Researchers will measure the amount of assistance being provided by the suspension device, construct a computer model that identifies head poses requiring the most support and how the neck muscles work to support the head, and build a suspension device that can be programmed with different levels of support provided based on therapist input and the predictions of the computer model. Children at the Little Light House, a development center for children with special needs in Tulsa, OK who have low muscle tone base, will use the device on a regular basis. They will be assessed to determine how well varying the support provided to the head promotes the child's ability to develop the muscular control needed to hold up their head independently. Outreach activities will be conducted to University of Tulsa undergraduate students involved in Make A Difference Engineering (MADE at TU), a student group dedicated to using engineering skills to meet the needs of disabled persons. Students from this group will be involved in non-safety-critical aspects of the project. This will educate them about rehabilitation engineering research and prepare them for graduate study and careers in this important area.This project includes three objectives to support the overall goal of developing a system to provide dynamic head/neck support for individuals with hypotonia. First, a biomechanical model of the neck will be developed that will integrate the muscles that provide appropriate head support in normal individuals. This model will then be further developed to account for changes due to hypotonia and the effect of a head support. Second, the model will be validated for hypotonic conditions in the presence of a head support. Finally, an active, dynamic head support device will be developed that can respond to the pose of the head, an individual's intent, and therapist input to promote strengthening of the neck muscles and an improved quality of life for the individual. The model will be developed to be functionally accurate, including appropriate muscles to fully model the function of the neck in maintaining head posture and account for differences in the response of hypotonic individuals. It will be developed in OpenSim using a combination of cadaveric, radiographic, and in vivo studies and validated against measurements made in collaboration with physical therapists. The device that is developed will be evaluated in a clinical setting to determine if it supports the rehabilitative goals of strengthening the neck and allowing more independent head support over time.

患有某些发育障碍的儿童通常不具备保持头部直立所需的颈部肌张力（或潜在的肌肉张力）。如果没有外部支撑，头部会垂向胸部、侧面或后面。这会带来其他并发症，例如流口水和无法保持正常凝视，并抑制孩子探索世界的能力，导致发育迟缓。目前的治疗实践是使用电缆和头带将孩子的头部悬挂在刚性支撑物上。这种刚性悬架只能提供一级被动支撑；它对支撑头部的帮助程度不能根据佩戴者的需要轻易改变。虽然这确实有助于消除不良头部姿势的一些症状和并发症，但它无助于帮助孩子学会通过自己的肌肉力量控制头部。它还禁止孩子在需要时向某些方向移动头部。这项研究汇集了训练有素的治疗师和工程师，他们将调查是否帮助孩子从难以做到的位置抬起头（例如，头部向前倾斜、向后倾斜或靠在肩膀上），并提供较少的帮助孩子更容易自己支撑头部，将促进发展对头部的独立控制，随着时间的推移，对支撑的需求也会减少。研究人员将测量悬挂装置提供的帮助量，构建一个计算机模型来识别需要最多支撑的头部姿势以及颈部肌肉如何工作来支撑头部，并构建一个可以通过不同级别的编程进行编程的悬挂装置。根据治疗师的输入和计算机模型的预测提供支持。 Little Light House 是俄克拉何马州塔尔萨市一家针对有特殊需要的儿童的发展中心，他们的肌张力基础较低，他们将定期使用该设备。他们将接受评估，以确定提供给头部的不同支撑能够在多大程度上促进儿童发展独立支撑头部所需的肌肉控制能力。外展活动将针对塔尔萨大学参与 Make A Difference Engineering (MADE at TU) 的本科生开展，这是一个致力于利用工程技能来满足残疾人需求的学生团体。该小组的学生将参与该项目的非安全关键方面。这将为他们提供关于康复工程研究的教育，并为他们在这一重要领域的研究生学习和职业生涯做好准备。该项目包括三个目标，以支持开发一个系统为张力减退患者提供动态头/颈部支撑的总体目标。 首先，将开发颈部的生物力学模型，该模型将整合为正常人提供适当头部支撑的肌肉。 然后将进一步开发该模型，以考虑由于肌张力低下和头部支撑的影响而引起的变化。 其次，该模型将在头部支撑存在的情况下针对低渗条件进行验证。 最后，将开发出一种主动、动态的头部支撑装置，它可以响应头部姿势、个人意图和治疗师的输入，以促进颈部肌肉的强化和个人生活质量的改善。 该模型将被开发为功能准确的模型，包括适当的肌肉来充分模拟颈部在维持头部姿势方面的功能，并考虑低张力个体反应的差异。 它将结合尸体、放射摄影和体内研究在 OpenSim 中开发，并根据与物理治疗师合作进行的测量进行验证。 所开发的设备将在临床环境中进行评估，以确定它是否支持加强颈部的康复目标，并随着时间的推移提供更独立的头部支撑。

项目成果

Effects of a Head Support on Children with Hypotonia in the Cervical Spine

头部支撑对颈椎张力减退儿童的影响

• DOI: 10.1109/embc44109.2020.9175744
• 发表时间: 2020-07
• 期刊: Proceedings of the 2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC
• 作者: Kerst, Bradford;Crouch, Lynda;Fox, Jamey;Wilson, Julie;Schultz, Joshua
• 通讯作者: Schultz, Joshua