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: 10582638
• 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 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10582638
• 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; Compensation; Devices; Disease; Distal; Elasticity; Elderly; Ensure; Exertion; Fatigue; Fibrosis; Flexor; 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; Specific qualifier value; Stress; Surveys; Testing; Torque; Treadmill Tests; Treatment Efficacy; United States Department of Veterans Affairs; Vascularization; Veterans; Visual; Walking; Work; analog; claudication; comorbidity; cost; design; exoskeleton; foot; future implementation; implementation trial; improved; light weight; male; mechanical force; muscle physiology; 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改善外周动脉患者的生活质量 使用辅助外骨骼的疾病（PAD）。 PAD是系统性动脉粥样硬化的表现， 显着降低了血液流向下肢。带有垫的退伍军人经历血管成形术， 近距离通道和远端旁路程序的速度比美国一般男性人口高10倍。 在行走时，血液流量减少会导致疼痛，称为lau不平。导致lau不平的疼痛 从PAD中导致患者步行较少，较慢，并且与健康相比失去独立性 同行。我们的研究已经确定了claudiricatientate患者的步行模式的功能限制， 其中最突出和一致的是骨肌肉肌肉的赤字，脚踝plantarflexors 在步行过程中产生健康的脚踝托鲁克和动力。精心设计的外骨骼将允许患者 垫子可以走更长的时间而不会疼痛或步行以减轻压力所需的距离 到受影响的腿。在可以在PAD患者中实施EF之前，必须将设计改进到 提高步行性能和实际使用患者。作为第一步，我们建议确定EF的影响 关于步行性能，关注EF如何促进生物踝关节扭矩的变化和 功率，能量成本和小腿肌肉氧合。我们将测试健康的老年人，以确保并确认 舒适，减少脚和小腿受伤的风险，并培养患者采用设备的高潜力 用垫子。然后将在PAD患者中评估EF。为此选择健康的老年人 初始阶段，因为像患有PAD的患者一样，它们在步行过程中产生的推动扭矩和功率较小 与健康的年轻人相比；使它们成为限制限制的合适型号。我们的具体目的是： 目标1：确定EF辅助力量水平的水平，从而产生更好的行走 较旧的主题的表现。 目标2：确定产生更好主题偏好的EF辅助力量的水平 在较旧的主题中。 目标3：确定EF援助水平对步行绩效的影响并报告 PAD患者的偏好。目标1和2结果将指导在此目标中测试的援助水平。 Nebraska将招募50名健康的AIM 1和2的健康老年人，以及25例AIM 3的患者 以及爱荷华州西部退伍军人事务中心的医疗中心和周围的奥马哈社区。 AIM 1将测试 七个条件，包括五个级别的EF援助，没有弹簧的EF和一个正常步行 健康）状况。下肢扭矩和功率将使用步态生物力学测量 跑步机持续三分钟。肌肉氧合将通过近红外光谱法测量 小腿肌肉。代谢推车将用于测量能源成本。 AIM 2将彻底评估 主题跨EF辅助的偏好。视觉模拟量表，感知锻炼的速度 和痛苦以及可行性访谈将为困难提供舒适和健康，疲劳和身体活动 主体以及EF的可接受性，需求和实用性。 AIM 3将评估步行 性能，能量成本，肌肉氧合和受试者报告的偏好方式与 在目标1和2中提出的建议，除了跑步机测试将是执行最大步行距离测试 在两个差异测试日内。我们假设将有一个EF援助水平来满足主题 - 报告了偏好和步行绩效目标。该建议将提供必不可少的 基本知识将建立EF效率并指导EF的规范规范 被患者使用PAD。