Exoskeleton footwear to improve walking performance and subject-reported preference.

外骨骼鞋可提高步行性能和受试者报告的偏好。

• 批准号: 10356831
• 负责人: Sara A Myers
• 金额: --
• 依托单位: OMAHA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10356831
• 关键词: 3-Dimensional; Activities of Daily Living; Address; Adopted; Adoption; Affect; Age; Angioplasty; Ankle; Arteries; Atherosclerosis; Benefits and Risks; Biological; Biomechanics; Blood flow; Bypass; Cardiovascular Diseases; Clinical Trials; Communities; Devices; Disease; Distal; Elderly; Ensure; Exertion; Fatigue; Fibrosis; Gait; Goals; Impairment; Individual; Injury; Intervention; Interview; Iowa; Ischemia; Knowledge; Laboratories; Leg; Lower Extremity; Measures; Medical center; Metabolic; Modeling; Morphology; Muscle; Muscle Cramp; Myopathy; Near-Infrared Spectroscopy; Nebraska; Orthotic Devices; Oxygen; Pain; Pain in lower limb; Participant; Patients; Pattern; Performance; Peripheral arterial disease; Phase; Physical activity; Population; Procedures; Quality of life; Questionnaires; Reporting; Research; Risk; Self-Help Devices; Severity of illness; Shapes; Stress; Surveys; Testing; Time; Torque; Treadmill Tests; Treatment Efficacy; United States Department of Veterans Affairs; Veterans; Visual; Walking; Work; analog; base; claudication; comorbidity; cost; design; exoskeleton; foot; future implementation; implementation trial; improved; light weight; male; mechanical force; muscle physiology; older patient; patient population; preference; recruit; satisfaction; sedentary; surgical service; treadmill

The long term goal of this project is to improve the quality of life of patients with peripheral artery disease (PAD) using assistive exoskeletons. PAD is a manifestation of systemic atherosclerosis that significantly reduces blood flow to the lower extremities. Veterans with PAD undergo angioplasty, proximal bypass, and distal bypass procedures at rates 10 times higher than the general US male population. Reduced blood flow leads to pain during walking known as claudication. Claudication pain that results from PAD causes patients to walk less and slower, and lose independence compared with their healthy counterparts. Our research has identified functional limitations in the walking patterns of claudicating patients, the most prominent and consistent of which is a deficit of the psterior calf muscles, the ankle plantarflexors, to generate healthy ankle toruqe and power during walking. A properly designed exoskeleton will allow patients with PAD to walk longer without pain or walk the distance needed for completing daily activities with less stress to the affected leg. Before EF can be implemented in patients with PAD, the design must be improved to increase walking performance and actual patient use. As a first step we propose to determine the effect of EF on walking performance, focusing on the how EF contributes to changes in the biological ankle torque and power, energy cost, and calf muscle oxygenation. We will test healthy older adults to ensure and confirm comfort, decrease risk of injury to the foot and calf, and cultivate high potential for device adoption in patients with PAD. The EF will then be evaluated in patients with PAD. Healthy older individuals are selected for this initial phase because like patients with PAD, they produce less push-off torque and power during walking compared with healthy young; making them an appropriate model for PAD limitations. Our specific aims are: Aim 1: To determine the levels of EF assistance force level which produce better walking performance in older subjects. Aim 2: To determine the levels of EF assistance force which produce better subject-reported preference in older subjects. Aim 3: To determine the effect of EF assistance levels on walking performance and subject-reported preference in patients with PAD. Aims 1 and 2 results will guide the assistance levels tested in this aim. 50 healthy older adults for Aims 1 and 2, and 25 patients with PAD for Aim 3 will be recruited from the Nebraska and Western Iowa Veterans Affairs’ Medical Center and surrounding Omaha community. Aim 1 will test seven conditions, including five levels of EF assistance, the EF with no spring and one normal walking condition. Lower extremity torque and power will be measured using gait biomechanics on the treadmill for three minutes per condition. Muscle oxygenation will be measured with near infrared spectroscopy of the calf muscles. A metabolic cart will be used to measure energy cost. Aim 2 will thoroughly assess subject-reported preference across levels of EF assistance. Visual analog scales, rate of perceived exertion and pain, and feasibility interviews will provide the comfort and fit, fatigue, and physical activity difficulty of subjects along with the acceptability, demand, and practicality of the EF. Aim 3 will assess walking performance, energy cost, muscle oxygenation, and subject reported preference in the same manner as proposed in Aims 1 and 2, except the treadmill tests will be maximal walking distance tests performed across two difference testing days. We hypothesize there will be an EF assistance level to satisfy subject- reported preference and walking performance goals. This proposal will provide essential fundamental knowledge that will establish EF efficacy and guide prescriptive specifications for EF to be adopted for use by patients with PAD.

该项目的长期目标是提高周围动脉患者的生活质量 使用辅助外骨骼的疾病（PAD） PAD 是全身动脉粥样硬化的一种表现。 血流明显减少了下肢的血流量，患有 PAD 的退伍军人接受血管成形术。 近端搭桥和远端搭桥手术的比率比一般美国男性人群高 10 倍。 血流量减少会导致行走时疼痛，称为跛行疼痛。 与健康人相比，外周动脉疾病（PAD）会导致患者行走次数减少、变慢，并失去独立性 我们的研究发现了跛行患者行走模式的功能限制， 其中最突出和最一致的是小腿后肌、踝跖屈肌的缺陷， 正确设计的外骨骼将使患者在行走时产生健康的踝关节扭力和力量。 使用 PAD 可以无痛地行走更远的距离，或者在压力更小的情况下行走完成日常活动所需的距离 在 PAD 患者实施 EF 之前，必须改进设计以 作为第一步，我们建议确定 EF 的效果。 步行表现，重点关注 EF 如何影响生物踝关节扭矩的变化以及 我们将测试健康的老年人，以确保和确认。 舒适度，降低足部和小腿受伤的风险，并培养患者采用设备的巨大潜力 然后将选择健康的老年人来评估 PAD 患者的 EF。 初始阶段，因为与 PAD 患者一样，他们在行走过程中产生的推离扭矩和功率较小 与健康年轻人相比；使他们成为 PAD 局限性的合适模型。 目标 1：确定可产生更好步行效果的 EF 辅助力水平 较老科目的表现。 目标 2：确定 EF 援助力量的水平，以产生更好的受试者报告偏好 在较老的科目中。 目标 3：确定 EF 援助水平对步行表现和受试者报告的影响 PAD 患者的偏好将指导该目标测试的援助水平。 目标 1 和 2 的 50 名健康老年人以及目标 3 的 25 名 PAD 患者将从内布拉斯加州招募 爱荷华州西部退伍军人事务部医疗中心和周边奥马哈社区将进行测试。 七种情况，包括五级 EF 辅助、无弹簧 EF 和 1 种正常行走 将使用步态生物力学测量下肢扭矩和功率。 每种情况下在跑步机上跑三分钟，用近红外光谱仪测量肌肉氧合情况。 小腿肌肉的代谢车将用于测量能量消耗。 受试者报告的不同级别的 EF 援助偏好、感知用力率。 和疼痛，可行性访谈将提供舒适度和适合度、疲劳度和身体活动难度 目标 3 的受试者以及 EF 的可接受性、需求和实用性将评估步行。 表现、能量成本、肌肉氧合和受试者以与 目标 1 和 2 中提出的，除了跑步机测试将进行最大步行距离测试 在两个不同的测试日中，我们约定将有一个 EF 援助水平来满足主题- 报告的偏好和步行表现目标将提供必要的信息。 基础知识将确定 EF 功效并指导 EF 规范规范 供 PAD 患者使用。