A novel mechanics-based intervention to improve post-stroke gait stability

一种新颖的基于力学的干预措施可改善中风后步态稳定性

• 批准号: 9397986
• 负责人: JESSE C. DEAN
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9397986
• 关键词: Acute; Address; Adult; American; Body Weight; Caring; Characteristics; Clinical; Communities; Data; Development; Devices; Effectiveness; Elements; Engineering; Environment; Equilibrium; Evidence based intervention; Failure; Fall prevention; Foundations; Future; Gait; Goals; Human; Incidence; Individual; Intervention; Investigation; Knowledge; Leg; Link; Location; Locomotor training; Measures; Mechanics; Methods; Mind; Motion; Movement; Neurologic; Neuromechanics; Participant; Patients; Pattern; Population; Positioning Attribute; Quality of life; Rehabilitation device; Rehabilitation therapy; Research; Robot; Speed; Stroke; Techniques; Testing; Therapeutic Intervention; Time; Veterans; Walking; Work; active control; base; clinical implementation; cost; design; dosage; experience; experimental study; fall risk; falls; fear of falling; follow-up; foot; gait rehabilitation; improved; intervention effect; kinematics; motor control; motor learning; new technology; novel; patient subsets; post stroke; prevent; prototype; rehabilitation paradigm; response; restoration; robot assistance; robot rehabilitation; robotic device; stroke intervention; stroke survivor; success; systematic review; treadmill; walking speed

Independent mobility, the ability of an individual to successfully and safely navigate through their environment, is a primary contributor to quality of life. Unfortunately, mobility often decreases following a stroke, preventing many stroke survivors from returning to typical levels of activity participation. A major contributor to reduced mobility is gait instability, which can limit function either by increasing the risk of falls or by increasing the fear of falling. Several existing rehabilitation techniques have been demonstrated to improve certain aspects of post-stroke gait function, such as increasing self-selected walking speed. However, these interventions have generally failed to address gait instability, as evidenced by a lack of improvement in fall risk. A likely reason for the limited effectiveness of current rehabilitation approaches is that they are not based on the unique mechanisms underlying post-stroke gait instability. A longer-term goal of this general line of research is to develop clinically-available, mechanism-based interventions to improve post-stroke gait stability. As a step toward accomplishing this goal, the project will focus on a potential mechanistic cause of instability suggested by preliminary work investigating how gait is stabilized among uninjured controls and stroke survivors. This approach contrasts with typical investigations of gait instability, which largely focus on quantifying non-causal indicators of stability rather than understanding the underlying mechanisms. The central hypothesis is that post-stroke disruptions in gait stability are often caused by a lack of mechanically-appropriate adjustments in foot placement location. While individuals with stable gait patterns actively control their foot placement based on the mechanical state of their center of mass, this evidence of active stabilization is often lacking after a stroke. The disruption of the typical gait stabilization strategy has motivated the recent construction of a prototype rehabilitation robotics device able to manipulate foot placement location. The objective of this proposal is to further develop this device and conduct initial testing of its ability to improve post-stroke gait stability, based on principles of motor learning. This will be accomplished through three Specific Aims. The first Specific Aim is to identify the simplest force-field control method able to effectively modulate foot placement. Several candidate control methods will be compared in terms of their ability to increase mechanically-appropriate foot placement modulation. The second Specific Aim is to determine whether the typical gait stabilization strategy can be restored by repeated gait practice while the force-field either: 1) encourages mechanically-appropriate foot placement; or 2) amplifies errors away from mechanically- appropriate target locations. These two intervention strategies are based on distinct theoretical frameworks. The “challenge point framework” suggests that mechanical assistance provided by the force-field may allow stroke survivors to experience (and relearn) a movement pattern they may otherwise be unable to accomplish. In contrast, the “error-driven adaptation” framework suggests that amplified kinematic errors may drive participants to actively resist these forces, producing beneficial after-effects in foot placement. The third Specific Aim will quantify the effects of patient baseline characteristics and dosage on the intervention’s effects, necessary data for future larger-scale trials. The proposed project is based on the combined theoretical frameworks of human gait mechanics and motor learning, and will quantify the potential of mechanism-based interventions using a novel force-field to restore the typical neuromechanical gait stabilization strategy in stroke survivors. The resultant knowledge has the potential to make an important contribution to the development of a larger-scale rehabilitation paradigm in which therapeutic interventions are targeted to a patient’s specific limitations.

独立移动性，个人成功、安全地穿越环境的能力， 不幸的是，中风后活动能力通常会下降，从而阻碍生活质量。 许多中风幸存者无法恢复到典型的活动参与水平。 活动能力是步态不稳定，它会通过增加跌倒的风险或增加恐惧来限制功能 一些现有的康复技术已被证明可以改善跌倒的某些方面。 然而，这些干预措施对中风后的步态功能有影响，例如增加自主选择的步行速度。 通常未能解决步态不稳定问题，跌倒风险缺乏改善就是一个可能的原因。 当前康复方法的有效性有限，因为它们并非基于独特的康复方法 中风后步态不稳定的潜在机制。 这一总体研究方向的长期目标是开发临床可用的、基于机制的药物 作为实现这一目标的一步，该项目将采取干预措施来改善中风后的步态稳定性。 重点关注调查步态的初步工作所提出的不稳定的潜在机械原因 这种方法与对未受伤对照组和中风幸存者的典型调查形成鲜明对比。 步态不稳定，主要侧重于量化稳定性的非因果指标，而不是理解 基本机制。 中心假设是中风后步态稳定性的破坏通常是由于缺乏 足部放置位置的机械适当调整，同时具有稳定步态模式的个体。 根据质心的机械状态主动控制脚的位置，这一证据表明 中风后通常缺乏主动稳定，典型的步态稳定策略被破坏。 激发了最近建造能够操纵足部的原型康复机器人设备 该提案的目的是进一步开发该设备并进行初步测试。 基于运动学习原理，其提高中风后步态稳定性的能力将得以实现。 通过三个具体目标。 第一个具体目标是确定能够有效调节足部的最简单的力场控制方法 将比较几种候选控制方法的增加能力。 第二个具体目标是确定机械上适当的足部放置调节。 典型的步态稳定策略可以通过重复步态练习来恢复，而力场：1) 鼓励机械上适当的足部放置；或 2) 放大机械上的错误 这两种干预策略基于不同的理论框架。 “挑战点框架”表明，力场提供的机械辅助可能允许 中风幸存者体验（并重新学习）他们可能无法完成的运动模式。 相比之下，“误差驱动的适应”框架表明，放大的运动误差可能会驱动 参与者积极抵抗这些力量，在放置中产生有益的后遗症。 具体目标将量化患者基线剂量特征和干预措施的影响 效果，为未来更大规模试验提供必要的数据。 所提出的项目基于人类步态力学和运动的组合理论框架 学习，并将量化基于机制的干预措施的潜力，使用一种新颖的力场来恢复 中风幸存者的典型神经机械步态稳定策略由此产生的知识有： 为更大规模康复模式的发展做出重要贡献的潜力 哪些治疗干预措施针对患者的具体限制。