Affordable Robot-Based Assessment of Cognitive and Motor Impairment in People Living with HIV and HIV-Stroke

经济实惠的基于机器人的艾滋病毒感染者和艾滋病毒中风患者认知和运动障碍评估

• 批准号: 10751316
• 负责人: MICHELLE J. JOHNSON
• 金额: $ 23.17万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10751316
• 关键词: AIDS dementia; Activities of Daily Living; Address; Affect; Africa; Africa South of the Sahara; African; Age; Botswana; Cardiovascular Diseases; Caring; Central Nervous System; Classification; Clinical; Cognitive; Collaborations; Country; Devices; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Education; Engineering; Environment; Evaluation; Face; Freedom; Gait; Goals; Grant; HIV; HIV Seronegativity; HIV-associated neurocognitive disorder; Health; Healthcare; Hepatitis C; High Prevalence; Hospitals; Human; Human Resources; Hypertension; Impaired cognition; Individual; Infection; Infrastructure; International; Learning; Measures; Meta-Analysis; Modeling; Motor; Nervous System Trauma; Neurocognitive; Neurocognitive Deficit; Neurologic; Neuropsychology; Participant; Patients; Pennsylvania; Persons; Prevalence; Quality of life; Rehabilitation therapy; Reporting; Research Personnel; Resources; Risk; Robot; Robotics; Screening procedure; Sensitivity and Specificity; Series; Standardization; Stroke; Substance abuse problem; Supervision; System; Target Populations; Technology; Testing; Time; Tobacco; Tobacco use; Training; Uganda; Universities; Upper arm; Validation; Validity and Reliability; Vascular Diseases; Viral Load result; Work; antiretroviral therapy; base; cognitive disability; cognitive function; cognitive testing; comorbidity; computerized; cost; cost effective; disability; exergame; haptics; innovation; lifestyle factors; low and middle-income countries; manufacture; motor impairment; neurocognitive disorder; neurological rehabilitation; novel; novel strategies; programs; prototype; recruit; rehabilitative care; repaired; robot assistance; robot rehabilitation; robot therapy; robotic system; screening; sex; stroke risk; stroke survivor; systematic review; technology platform; tool; treatment program; usability

PROJECT SUMMARY About 37 million people live with human immunodeficiency virus (HIV) worldwide and about 71% of people living with HIV (PLWH) reside in low and middle income countries (LMICs). HIV enters the central nervous system (CNS) early after infection and increases the risk for mild-to-severe neurocognitive and cardiovascular disorders. Studies show that about 30 to 40% of PLWH will have neurologic complications leading to long-term motor and cognitive disability, including HIV-Associated Neurocognitive Disorders (HAND). Few studies have examined how best to provide objective assessment, diagnostic, and rehabilitative treatment tools to aid people living with disabilities as a result of HIV and HIV-stroke in LMICs. The need for these tools is great in LMICs, given the greatly limited infrastructure and healthcare resources and thus decreased access to consistent, quality rehabilitation. Our long-term goal is to develop innovative and affordable robot technologies to bridge healthcare care gaps in LMICs and leverage them to help objectively assess, diagnose and treat PLWH presenting with motor and cognitive impairment due to HAND and Stroke. In this R21 project, we leverage our affordable robot therapy system augmented with objective metrics and motor and cognitive exergames to assess PLWH in Botswana—a country with the fourth highest HIV prevalence rate (20.3%) in the world, an increasing NCD prevalence rate, and limited rehab resources. Aim 1 determines concurrent validity and reliability of using the robot therapy system to objectively ASSESS cognitive, and motor impairments in PLWH. Forty (40) PLWH and 40 HIV-negative controls will be evaluated using both clinical metrics and new robot-based metrics at two time points, at least 1-week apart. We hypothesize that robot-based metrics will have test-retest reliability as well as concurrent validity with clinical measures of motor and cognitive function that usually require rehabilitation expertise and man-power to complete. Aim 2 determines the feasibility of developing a robot-based classification of HIV-associated neurocognitive disorders (HAND). 80 PLWH without stroke will be evaluated using an augmented neuropsychological (NP) battery required to meet minimal HAND Frascati criteria and the robot assessment tasks. We will use the Frascati criteria and global deficit scoring (GDS) to classify the PLWH participants into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV- associated dementia (HAD). We will develop a regression model using derived robot metrics and test its ability to predict HAND and GDS score. We hypothesize that the robot-based model will classify HAND with specificity and sensitivity better than HAND screening with International HIV Dementia Scale and Montreal Cognitive Assessment. The Receiver Operator Curve (ROC) will be used as empirical validation. Demographic, HIV, and lifestyle factors such as age, viral load, hypertension, diabetes, hepatitis C, and tobacco will be used to determine which increased the risk for HAND.

项目概要 全球约有 3700 万人感染人类免疫缺陷病毒 (HIV)，其中约 71% 的人感染艾滋病毒 居住在低收入和中等收入国家 (LMIC) 的艾滋病毒携带者 (PLWH) 艾滋病毒进入中枢神经系统。 （中枢神经系统）感染后早期，并增加轻度至重度神经认知和心血管疾病的风险。 研究表明，约 30% 至 40% 的感染者会出现神经系统并发症，导致长期运动和运动障碍。 认知障碍，包括 HIV 相关神经认知障碍 (HAND) 的研究很少。 如何最好地提供客观的评估、诊断和康复治疗工具来帮助患有此病的人们 鉴于中低收入国家因艾滋病毒和艾滋病毒中风导致的残疾，中低收入国家对这些工具的需求很大。 基础设施和医疗保健资源受到极大限制，从而减少了获得一致、优质的服务的机会 我们的长期目标是开发创新且价格实惠的机器人技术来连接医疗保健。 中低收入国家的护理差距，并利用它们来帮助客观评估、诊断和治疗患有以下疾病的 PLWH： 手部和中风导致的运动和认知障碍 在这个 R21 项目中，我们利用了我们负担得起的产品。 机器人治疗系统增强了客观指标以及运动和认知运动游戏来评估 博茨瓦纳的艾滋病感染者和艾滋病病毒感染者——该国艾滋病毒感染率位居世界第四（20.3%）， 非传染性疾病患病率和有限的康复资源决定了使用的同时有效性和可靠性。 机器人治疗系统客观评估 PLWH 的认知和运动障碍。四十 (40) PLWH。 和 40 个 HIV 阴性对照将在两个时间使用临床指标和新的基于机器人的指标进行评估 时间点，至少相隔 1 周，我们勇敢地说基于机器人的指标也将具有重测可靠性。 与通常需要康复的运动和认知功能的临床测量同时有效 目标 2 确定了开发基于机器人的分类的可行性。 将使用 80 名无中风的 PLWH 进行评估。 满足最低 HAND Frascati 标准和机器人所需的增强神经心理学 (NP) 电池 我们将使用弗拉斯卡蒂标准和全球赤字评分（GDS）对 PLWH 进行分类。 患有无症状神经认知障碍（ANI）、轻度神经认知障碍（MND）和艾滋病毒的参与者 我们将使用派生的机器人指标开发回归模型并测试其能力。 预测 HAND 和 GDS 分数 我们勇敢地说基于机器人的模型将对 HAND 进行特异性分类。 和敏感性优于国际艾滋病痴呆量表和蒙特利尔认知的 HAND 筛查 评估。接受者操作曲线（ROC）将用作经验验证。 年龄、病毒载量、高血压、糖尿病、丙型肝炎和烟草等生活方式因素将用于确定 这增加了手的风险。