Wearable Ankle Assistance to Improve Walking Economy in Children with Cerebral Palsy

可穿戴式踝关节辅助装置可改善脑瘫儿童的步行经济性

• 批准号: 9812719
• 负责人: Zachary Forest Lerner
• 金额: $ 42.39万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-06 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812719
• 关键词: Academic Research Enhancement Awards; Address; Adult; Affect; Age; Ankle; Arizona; Biomechanics; Biomedical Engineering; Cardiovascular Diseases; Cerebral Palsy; Characteristics; Child; Childhood; Clinical; Clinical effectiveness; Communities; Data; Doctor of Philosophy; Dose; Equilibrium; Fatigue; Flexor; Frequencies; Functional disorder; Future; Gait; Gait abnormality; Goals; Guidelines; Home environment; Individual; Injections; Intervention Studies; Joints; Knowledge; Limb structure; Mechanics; Metabolic; Metabolic dysfunction; Muscle; Orthopedic Surgery procedures; Orthotic Devices; Osteoporosis; Outcome; Participant; Pathologic; Patients; Pattern; Performance; Personal Satisfaction; Phase; Physical activity; Physical therapy; Physically Handicapped; Physiological; Play; Population; Posture; Power Walking; Quality of life; Research; Research Design; Research Project Grants; Role; Secondary to; Self-Help Devices; Severities; Speed; Spinal cord injury; Stroke; Students; Time; Training; Universities; Walking; Weight-Bearing state; Work; ankle joint; chronic pain; clinically relevant; cost; design; disability; exoskeleton; foot; gait rehabilitation; improved; insight; mobility aid; motor deficit; novel; patient population; physical conditioning; programs; response; spasticity; therapy design; treadmill

PROJECT SUMMARY/ABSTRACT The ability of children to walk effectively is essential to their physical health and general well-being. Unfortunately, many children with cerebral palsy (CP), the most common cause of pediatric physical disability, have difficulty walking and completing balance-intensive weight-bearing tasks. This leads to children with CP engaging in levels of habitual physical activity that are well below guidelines and those of children without disabilities, which in turn contributes to many secondary conditions, including metabolic dysfunction and cardiovascular disease. The pathological gait patterns and reduced stability caused by CP are due, in part, to diminished function of the ankle plantar- and dorsi-flexor muscles. The negative relationship between the energy cost of walking and amount of accumulated physical activity in children with CP underscores the need for new strategies to drastically improve walking economy in this population. To meet this goal, our proposal aims to evaluate the novel use of powered ankle assistance from a wearable exoskeleton to improve walking economy across varied terrain in children with CP. The first specific aim is to quantify how the magnitude of powered plantar-flexor assistance affects the energetics and mechanics of over-ground walking at self-selected speeds, treadmill walking at set speeds, and stair stepping at a constant rate in CP. It is hypothesized that an optimal level of assistance will be identified for each task that maximizes improvements in energy cost of transport, posture, and positive ankle power compared to unassisted walking conditions. The second specific aim is to evaluate how training frequency and patient characteristics affect clinical and biomechanical gait outcomes across repeated over-ground walking sessions with powered ankle assistance in CP. Individuals with gait deficits from CP will be randomly selected to complete 30 minutes of over-ground gait training with individually-tuned plantar-flexor assistance 2x/week for 4 weeks or 4x/week for 2 weeks. Walking economy and speed will be assessed at the beginning, middle, and end of the training period. It is hypothesized that higher frequency training and total powered walking time will be positively associated with gait outcomes, while GMFCS level and spasticity severity will be negatively associated with gait outcomes. The fundamental knowledge gained from this proposal will result in safe and effective control parameters for powered plantar-flexor assistance during over-ground and stair walking in children with CP, and provide insight on training and participant characteristics that can inform the design of future intervention studies. Through supporting student research involvement, this Academic Research Enhancement Award will help grow our new Center for Bioengineering and Bioengineering PhD program at Northern Arizona University.

项目概要/摘要 儿童有效行走的能力对于他们的身体健康和整体福祉至关重要。很遗憾， 许多患有脑瘫 (CP) 的儿童（小儿身体残疾的最常见原因）都存在困难 步行和完成平衡密集型负重任务。这导致 CP 儿童参与水平 远低于指导方针和非残疾儿童的习惯性身体活动，这反过来又 导致许多继发性疾病，包括代谢功能障碍和心血管疾病。这 CP 引起的病理步态模式和稳定性降低部分是由于踝关节功能减弱 跖屈肌和背屈肌。步行的能量消耗与步行量之间存在负相关关系 脑瘫儿童累积的体力活动强调需要新的策略来大幅改善 这个人群的步行经济。为了实现这一目标，我们的提案旨在评估动力的新颖用途 可穿戴外骨骼的脚踝辅助可改善患有不同地形的儿童的步行经济性 CP。第一个具体目标是量化动力跖屈肌辅助的幅度如何影响 以自选速度进行地面行走、以设定速度在跑步机上行走的能量学和力学，以及 CP 中以恒定速率步进的楼梯。假设将确定最佳援助水平 与相比，每项任务都能最大限度地改善运输、姿势和正踝关节力量的能量成本 到无辅助行走的条件。第二个具体目标是评估培训频率和患者的情况 特征影响重复地面行走过程中的临床和生物力学步态结果 CP 中配有动力脚踝辅助。患有 CP 步态缺陷的个体将被随机选择来完成 30 分钟的地面步态训练，并单独调整跖屈肌辅助，每周 2 次，持续 4 周或 每周 4 次，持续 2 周。步行的经济性和速度将在开始、中间和结束时进行评估 培训期。假设更高频率的训练和总动力步行时间将呈正向增长 与步态结果相关，而 GMFCS 水平和痉挛严重程度与步态呈负相关 结果。从该提案中获得的基础知识将导致安全有效的控制 脑瘫儿童在地面和楼梯行走期间动力跖屈肌辅助的参数，以及 提供有关培训和参与者特征的见解，可以为未来干预研究的设计提供信息。 通过支持学生的研究参与，该学术研究增强奖将帮助学生成长 我们在北亚利桑那大学的新生物工程中心和生物工程博士项目。