Robotic Knee Exoskeleton to Reduce Joint Loading and Improve Mobility in Veterans with Medial Compartment Knee Osteoarthritis

机器人膝关节外骨骼可减轻膝关节内侧骨关节炎退伍军人的关节负荷并提高其活动能力

• 批准号: 10016814
• 负责人: Patrick Mark Aubin
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016814
• 关键词: Adult; Affect; Aging; Behavior; Biomechanics; Data; Data Analyses; Degenerative polyarthritis; Development; Disabled Persons; Disease Progression; Dose; Effectiveness; Employment; Gait; Generations; Health; Individual; Intelligence; Kinetics; Knee; Knee Osteoarthritis; Knee joint; Knowledge; Laboratories; Lateral; Machine Learning; Manuals; Measures; Medial; Methods; Minor; Motion; Numeric Rating Scale; Operative Surgical Procedures; Pain; Participant; Pathogenesis; Patient Self-Report; Patients; Performance; Phase; Play; Population; Quality of life; Recreation; Replacement Arthroplasty; Reporting; Research; Research Personnel; Rest; Risk; Risk Factors; Robotics; Role; Scheme; Specific qualifier value; Symptoms; System; Systems Analysis; Testing; Time; United States; User Compliance; Veterans; Walking; Woman; aged; burden of illness; comparative efficacy; design; exoskeleton; experience; functional improvement; head-to-head comparison; improved; improved mobility; instrument; invention; joint function; joint loading; joint mobilization; kinematics; knee pain; mechanical load; men; modifiable risk; osteoarthritis pain; pain reduction; pain relief; preference; pressure; recruit; research study; response; robot exoskeleton; tool; treadmill; treatment strategy

Symptomatic knee osteoarthritis (OA) is a painful condition that reduces mobility, independence, and quality of life for both men and women. About 10% of people aged over 55 years have painful disabling knee OA of whom one quarter are severely disabled. Although a variety of factors influence the pathogenesis of OA, medial compartment knee joint contact loading plays a significant role and importantly, is a modifiable risk factor. Traditional knee unloader braces are a common conservative treatment strategy for those with medial compartment knee OA. Unloader braces are designed to unload the medial compartment of the knee joint thereby slowing disease progression, reducing pain, and improving joint function and mobility. Medial compartment unloading provided by a brace abduction moment (BAM) counteracts the external knee adduction moment (KAM). Unfortunately, traditional knee unloader braces have mixed efficacy and the limited benefits (minimal reduction in pain and minor functional improvements) of wearing the brace do not often outweigh the brace discomfort and hassle of use. One of the shortcomings of traditional knee unloader braces is that the BAM must be manually set by the brace user through strapping and or condyle pad adjustment. This results in infrequent adjustment which often causes an inappropriate BAM setting for a given activity, e.g. strapping has loosened resulting in a BAM that doesn’t provide enough knee unloading during gait, or the subject is at rest but the BAM remains high causing pressure and discomfort at the brace interface. Even when walking BAM modulation within a step could be beneficial. In this scenario, BAM could be reduced during swing phase but then return to a normal level during stance phase. For these reasons, we propose that a new class of smart active braces that dynamically adapt the amount of unloading for a given individual and their activity. This new class of braces has the potential to provide greater medial compartment knee unloading and better pain relief while simultaneously being more comfortable. Therefore, the purpose of this research study is to determine optimal BAM modulation profiles that provide better medial compartment knee unloading, improve brace comfort and reduce knee pain as compared to conventional passive knee unloader braces. To achieve our aims, we have developed an offboard robotic knee exoskeleton (RKE) to serve as a laboratory tool to investigate the potential benefits of active braces with dynamic BAM modulation. For this study, twenty participants will be recruited to walk on an instrumented treadmill while wearing the (RKE). The participants will experience 56 different BAM modulation schemes as parameterized by the BAM turn on time (Ton), turn off time (Toff) and peak Nm BAM level (Pk). Real-time data analysis will allow us to immediately compare the efficacy of each BAM modulation scheme in terms of medial compartment knee unloading (knee adduction angular impulse, KAAI) and brace comfort (brace abduction angular impulse, BAAI). Study participants will then experience a direct comparison of walking with the RKE emulating a traditional passive unloader brace versus walking with the RKE programmed with the identified optimal BAM. Here the participants will self-select their own preferred unloading level (BAM Pk) for each brace type. Self-reported knee pain and brace comfort, as well as KAAI and BAAI of the passive versus active brace will then be compared. These results will allow us to determine if dynamic active braces that deliver intra-step BAM modulation can provide equal or better medial compartment knee unloading (KAAI) while simultaneously being more comfortable and greater pain relief. The development of improved knee unloader braces, that are smart, dynamic, and adaptive have the potential to greatly increase brace efficacy. Improved conservative treatment strategies for medial compartment knee OA could reduce surgical intervention and its associated risks and significantly improve the quality of life for veterans burdened by this disease.

有症状的膝盖骨关节炎（OA）是一种痛苦的内容，可降低，独立性和质量 男人和女人的生活。 尽管有多种因素会影响OA的发病机理，但四分之一 内侧隔室膝关接触载荷起着重要作用，重要的是， 因素。 车厢膝盖OA在这里。 疾病的进展减慢，减轻疼痛以及改善关节功能和迁移率 支架绑架时刻（BAM）提供的隔室卸载抵消了外部膝盖 不幸的是，传统的膝盖卸载器牙套具有混合功效，有限 佩戴支架的好处（减少疼痛和轻微的功能改善）并不经常 超过括号的不适和麻烦。 是BAM必须通过绑带和 /或Condyle Pad调整手动设置 结果很少调整，这通常会导致给定活动的不适当的BAM设置，例如 绑带松开了，导致BAM在或您期间没有足够的膝盖卸载 受试者处于静止状态，但BAM仍然在支撑界面上引起促销和不适。 在这种情况下，在步骤中行走时可能是有益的 挥杆阶段，但由于这些原因，我们提出了一个新的阶段。 一类智能主动括号，可以动态调整给定个人及其的卸载量 活动。 更好地缓解疼痛，同时更舒适。 研究是为了确定主要主导内侧隔室膝盖的最佳BAM调制曲线 卸载，改善支撑舒适度并减轻膝盖疼痛，以填补传统的被动膝盖 卸载器的牙套。 作为一种通过动态BAM调制的活动牙套的潜在优势，用作负责实用工具。 在这项研究中，将招募二十名参与者在佩戴跑步机上行走 （RKE）。 打开时间（TON），关闭时间（TOFF）和峰值NM BAM级别（PK）。 立即根据内侧室膝盖比较每个BAM调节方案 卸载（膝盖内收脉冲，kaai）和支撑舒适度（支撑绑架角脉冲，baai）。 研究参与者将直接比较步行与RKE模拟传统的直接比较 被动卸载器支架与使用已确定的最佳BAM编程的RKE行走。 参与者将为每种支架类型自我选择自己的首选卸载水平（BAM PK）。 膝盖疼痛和支撑舒适，以及被动与活跃支架的Kaai和Baai将是十只蜜蜂 将这些结果进行比较。 调节可以提供相等或更好 更舒适，更大的疼痛。 动态和自适应有可能大大提高支架撑杆功效。 内侧隔室的策略可以减少手术干预措施，并具有相关的风险和风险，并且 显着改善了因这种疾病负担的退伍军人的生活质量。