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.

项目摘要/摘要 儿童有效行走的能力对于他们的身体健康和一般福祉至关重要。很遗憾， 许多脑瘫（CP）的儿童是小儿身体残疾的最常见原因 步行并完成平衡密集的承重任务。这导致患有CP的孩子参与水平 习惯性体育锻炼远低于准则和没有残疾儿童的习惯性运动，这反过来又 导致许多次要疾病，包括代谢功能障碍和心血管疾病。这 病理步态模式和由CP引起的稳定性降低，部分原因是脚踝的功能降低 足底和背部肌肉。步行的能源成本与数量之间的负相关关系 CP儿童积累的体育锻炼强调了对新策略的需求，以极大的改善 在这个人群中的步行经济。为了实现这一目标，我们的建议旨在评估有能力的新颖使用 可穿戴外骨骼的踝关节辅助，以改善患有不同地形的步行经济 CP。第一个具体目的是量化动力的plantar屈光者援助的幅度如何影响 以自选择的速度行走的能量和机制，以固定速度行走，跑步机和 楼梯以CP的恒定速率踏上阶梯。假设将确定最佳的援助水平 每项任务可最大程度地提高运输，姿势和积极脚踝的能力的提高 无助的步行条件。第二个特定目的是评估训练频率和患者的方式 特征会影响重复的地面步行课程的临床和生物力学步态结果 在CP中有动力的脚踝帮助。 CP的步态缺陷的个体将随机选择以完成 30分钟的越过步态训练，单独调整的足底反射器帮助2倍/周，持续4周或 4倍/周2周。步行经济和速度将在开始时，中间和结尾进行评估 培训期。假设更高的频率训练和总动力步行时间将是积极的 与步态结局相关，而GMFCS级别和痉挛性严重程度将与步态负相关 结果。从该提案中获得的基本知识将导致安全有效的控制 在CP儿童的地面和楼梯行走期间，有动力的足底屈光者援助的参数， 提供有关培训和参与者特征的见解，这些特征可以为未来的干预研究设计提供信息。 通过支持学生研究参与，该学术研究增强奖将有助于增长 我们在北亚利桑那大学的新生物工程和生物工程博士计划。