A Joint-Coupled Controlled-Brake Orthosis System for Hybrid FES Gait Restoration

用于混合 FES 步态恢复的关节耦合控制制动矫形器系统

• 批准号: 8303303
• 负责人: Michael Goldfarb
• 金额: $ 41.67万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8303303
• 关键词: Address; Bladder; Cardiovascular system; Characteristics; Clinical; Clinical Trials; Computers; Coupled; Couples; Coupling; Data Collection; Decubitus ulcer; Development; Effectiveness; Electric Stimulation; Event; Exertion; Failure; Fatigue; Freedom; Gait; Health; Hip Joint; Hip region structure; Hybrids; Impairment; Incidence; Individual; Injury; Intestines; Isometric Exercise; Joints; Knee; Knee joint; Leg; Limb structure; Locomotion; Lower Extremity; Mechanics; Metabolic; Microcomputers; Morale; Muscle; Muscle Fatigue; Orthotic Devices; Osteoporosis; Paralysed; Paraplegia; Persons; Physiological; Population; Quality of life; Research; Research Design; Research Methodology; Research Personnel; Risk; Self Perception; Source; Spinal cord injury; Study Section; Surface; System; Testing; Torque; United States; Walkers; Walking; Wheelchairs; Work; arm; base; cost; design; improved; psychologic; quadriceps muscle; research study; restoration; self esteem; sensor; simulation; success; Address; Bladder; Cardiovascular system; Characteristics; Clinical; Clinical Trials; Computers; Coupled; Couples; Coupling; Data Collection; Decubitus ulcer; Development; Effectiveness; Electric Stimulation; Event; Exertion; Failure; Fatigue; Freedom; Gait; Health; Hip Joint; Hip region structure; Hybrids; Impairment; Incidence; Individual; Injury; Intestines; Isometric Exercise; Joints; Knee; Knee joint; Leg; Limb structure; Locomotion; Lower Extremity; Mechanics; Metabolic; Microcomputers; Morale; Muscle; Muscle Fatigue; Orthotic Devices; Osteoporosis; Paralysed; Paraplegia; Persons; Physiological; Population; Quality of life; Research; Research Design; Research Methodology; Research Personnel; Risk; Self Perception; Source; Spinal cord injury; Study Section; Surface; System; Testing; Torque; United States; Walkers; Walking; Wheelchairs; Work; arm; base; cost; design; improved; psychologic; quadriceps muscle; research study; restoration; self esteem; sensor; simulation; success

DESCRIPTION (provided by applicant): The objective of this research is to restore the ability to walk to spinal cord injured (SCI) individuals. Previous studies (by several researchers) have demonstrated that FES can effectively restore legged mobility (with the help of a stability aid), and that such legged mobility can provide significant physiological and psychological benefits to SCI users. Due to the potential of collapse (from muscle fatigue) and the need to guide uncontrolled degrees of freedom, hybrid systems appear to offer the greatest promise for commercially viable gait restoration. As such, recent efforts by various researchers have focused (and are focusing) on the development of hybrid systems. Despite this, a commercially viable hybrid FES system does not yet exist. The intent of this proposal is to develop a commercially feasible gait restoration system, namely one that eliminates the possibility of collapse (due to muscle fatigue), has a low threshold for implementation and use, provides a stable, efficient gait (i.e., a swing-through gait primarily powered by the lower limbs), and is donned and doffed independently and with a minimal level of effort. The proposed system utilizes a hybrid FES approach, which combines two channels of surface stimulation (quadriceps of each leg) with a unique microcomputer-controlled orthosis, called a joint-coupled controlled-brake orthosis (JCO), the combination of which provides a stable, safe, commercially viable gait restoration system for paralyzed persons. Specifically, the use of surface stimulation pro- vides a low threshold of implementation, but at the cost of limited muscular access (i.e., inability to directly access deep hip flexion muscles). This limitation is addressed by the orthosis, which includes a mechanical biasing of the knee joint and unidirectionally couples knee flexion to hip flexion, and with this combination pro- vides the hip and knee flexion required for reliable swing-through gait. The effect of muscle fatigue is greatly diminished by utilizing unique controllable brakes at the hip and knee joints to provide isometric torques (in place of muscle stimulation), and since the knee brakes are normally locked, the risk of collapse is essentially eliminated (even in the event of a power failure). The orthosis provides for smooth, repeatable control of limb trajectories, which is enabled by the combination of joint angle sensors and the proportionally controllable brakes, which are used to guide the limbs (i.e., joint angles) along a desired trajectory. Since the power for gait is provided by metabolic sources, the orthosis requires a minimal amount of on-board power. Finally, the approach is designed to facilitate independent donning and doffing with minimal user effort. As such, the pro- posed system has the characteristics (i.e., fail-safe, low fatigue, moderate exertion, easy don/doff, low electric- al power requirements) of a commercially viable self-contained gait restoration system. If successful, the pro- posed approach could transition in a direct manner to a viable commercial product, and therefore could significantly improve the quality of life of many SCI individuals suffering from complete paralysis of the lower limb. PUBLIC HEALTH RELEVANCE: There are currently about 255,000 spinal cord injured individuals in the United States, with roughly 12,000 new injuries sustained each year, of which approximately 6300 of these (cases per year) result in complete paralysis of the legs with sufficient remaining arm functionality to potentially use the proposed gait restoration approach. Among the significant impairments resulting from paraplegia is the loss of legged mobility. The system proposed herein is intended as a supplement to (and not as a replacement of) a wheelchair, and in particular is intended to provide many of the physiological and psychological benefits of legged mobility that a wheelchair cannot, such as decreased osteoporosis, reduced incidence of decubitus ulcers, improved cardiovascular health, improved bowel and bladder function, reduced spasticity, and increased morale, self-image, and self- esteem.

描述（由申请人提供）：这项研究的目的是恢复步行到脊髓受伤（SCI）个体的能力。先前的研究（由几位研究人员）表明，FES可以有效地恢复腿部的移动性（借助稳定辅助工具），并且这种腿部的移动性可以为SCI使用者提供重大的生理和心理益处。由于崩溃的潜力（来自肌肉疲劳）以及指导不受控制的自由度的需求，混合系统似乎为商业上可行的步态恢复提供了最大的希望。因此，各种研究人员的最新努力集中在（并着重于）混合系统的发展上。尽管如此，商业上可行的混合FES系统尚不存在。 The intent of this proposal is to develop a commercially feasible gait restoration system, namely one that eliminates the possibility of collapse (due to muscle fatigue), has a low threshold for implementation and use, provides a stable, efficient gait (i.e., a swing-through gait primarily powered by the lower limbs), and is donned and doffed independently and with a minimal level of effort.拟议的系统利用了一种混合FES方法，该方法将表面刺激的两个渠道（每条腿的股四头肌）与独特的微型计算机控制的矫形器（称为联合耦合的控制制动器矫形器（JCO））相结合，其组合提供了一个稳定，安全，可靠，可靠，可靠，可靠的步态恢复的人。具体而言，表面刺激的使用可能会导致较低的实施阈值，但以有限的肌肉通道（即无法直接进入深髋屈曲肌肉）为代价。矫形器解决了这一限制，其中包括膝关节的机械偏置和单向夫妻膝盖屈曲以髋屈曲，并且这种组合可以使臀部和膝盖屈曲可靠，以实现可靠的挥杆步态。通过利用臀部和膝关节的独特可控制动器来提供等距扭矩（代替肌肉刺激），并且由于膝盖制动器通常被锁定，因此基本消除了膝盖制动器的风险（即使发生电力失效），可以大大减少肌肉疲劳的影响。矫形器提供了对肢体轨迹的平稳，可重复的控制，这是通过关节角传感器和相对可控制的制动器的组合来实现的，这些制动器用于引导沿所需轨迹的肢体（即关节角）。由于步态的功率由代谢来源提供，因此矫形器需要最少的车载功率。最后，该方法旨在以最少的用户工作来促进独立的捐赠和分手。因此，拟合系统具有商业上可行的自动性步态恢复系统的特征（即，失败，疲劳，低疲劳，中等劳动，轻松的don/doff，低电力需求）。如果成功的话，采用的方法可以直接过渡到可行的商业产品，因此可以显着改善许多患有下肢完全麻痹的SCI个体的生活质量。公共卫生相关性：美国目前约有255,000名脊髓受伤的人，每年大约有12,000个新伤害，其中约有6300个（每年）（每年）完全麻痹了腿部，具有足够的剩余ARM功能，可以潜在地使用拟议的步态恢复方法。截瘫引起的重大障碍是失去腿部流动性。 The system proposed herein is intended as a supplement to (and not as a replacement of) a wheelchair, and in particular is intended to provide many of the physiological and psychological benefits of legged mobility that a wheelchair cannot, such as decreased osteoporosis, reduced incidence of decubitus ulcers, improved cardiovascular health, improved bowel and bladder function, reduced spasticity, and increased morale, self-image, and自尊。