Real-Time Model-Based Gait Retraining for Knee Osteoarthritis Rehabilitation

基于实时模型的膝骨关节炎康复步态再训练

基本信息

批准号：
7305926
负责人：
BENJAMIN J FREGLY
金额：
$ 20.84万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-12 至 2009-08-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The long term objective of this application is to develop a novel rehabilitation approach to slow the progression of knee osteoarthritis, resulting in improved function and reduced pain for millions of patients. Unlike traditional rehabilitation approaches, the proposed approach is quantitative, combining patient-specific computer models with experimental gait analysis. The computer models are used to predict altered yet natural looking gait patterns that reduce detrimental knee loads. Subsequent gait analysis with real-time visual feedback is then used to train the patient to match the knee loads predicted by the computer model. The specific load targeted by gait retraining is the external knee adduction torque (i.e., the moment that contributes to medial compartment force), since this load is a strong indicator of knee osteoarthritis severity and progression. Initial application of the approach to two subjects but without real-time visual feedback yielded reductions as large as 50% in both peaks of the adduction torque curve, comparable to the results of high tibial osteotomy surgery but without surgical intervention. To investigate the feasibility of this long term objective, we propose to pursue three specific aims in a feasibility study study involving 10 patients with early knee osteoarthritis: Specific aim 1: Predict with a patient-specific computational model whether similar gait modifications exist for each patient that will significantly reduce both knee adduction torque peaks. Specific aim 2: Determine whether patients can achieve significant knee adduction torque reductions after eight gait retraining sessions using real-time model-based visual feedback. Specific aim 3: Determine whether significant knee adduction torque reductions can be maintained for at least one month following the completion of the gait retraining program. If successful, the proposed approach may permit customized gait retraining to be used to slow the progression of knee osteoarthritis or even as a preventative measure. The end result could be millions of patients with decreased pain and improved function who can delay or even avoid knee replacement surgery. Knee osteoarthritis afflicts millions of people in the United States, causing pain and limiting the ability to perform important daily activities such as walking and stair climbing. Using patient-specific computer models and experimental gait analysis, this research seeks to develop a novel rehabilitation approach to slow the progression of the disease. If successful, the approach would allow many patients to delay or possibly even avoid the need for knee replacement surgery in the future.

描述（由申请人提供）：本申请的长期目标是开发一种新型的康复方法，以减慢膝盖骨关节炎的进展，从而改善功能和数百万患者的疼痛。与传统的康复方法不同，所提出的方法是定量的，将患者特定的计算机模型与实验步态分析相结合。计算机模型用于预测改变但自然的步态模式，以减少有害的膝盖负荷。然后使用实时视觉反馈进行随后的步态分析来训练患者以匹配计算机模型预测的膝盖负荷。步态再培训靶向的特定负荷是外膝盖内收扭矩（即有助于内侧腔室力的时刻），因为这种负荷是膝关节骨关节炎的严重程度和进展的强烈指标。该方法最初应用于两个受试者，但没有实时的视觉反馈，在加合扭矩曲线的两个峰值中，降低了50％，与高胫骨截骨术手术的结果相当，但没有手术干预。为了研究这个长期目标的可行性，我们建议在一项可行性研究中追求三个特定目标，涉及10名患有早期膝关节骨关节炎的患者：特定目标1：通过患者特异性计算模型进行预测，每个患者是否存在相似的步态修饰，是否会显着降低两个膝盖添加率峰值。具体目标2：确定患者使用基于实时模型的视觉反馈进行了八次步态再培训课程后是否可以实现明显的膝盖内收扭矩降低。特定目标3：确定步态再培训计划完成后至少一个月可以维持显着的膝盖内收扭矩降低。如果成功，则提出的方法可以允许定制的步态再培训用于减慢膝盖骨关节炎的进展，甚至可以作为预防措施。最终结果可能是数百万的患者疼痛减轻和功能改善，这些患者可以延迟甚至避免膝盖置换手术。膝盖骨关节炎遭受了美国数以百万计的人，导致疼痛并限制了进行重要日常活动的能力，例如步行和爬楼梯。该研究使用特定于患者的计算机模型和实验步态分析，试图开发一种新型的康复方法来减缓疾病的发展。如果成功，该方法将使许多患者将来延迟或甚至可能避免需要进行膝盖置换手术。