Active Head Support for Children with Hypotonia

患有某些发育障碍的儿童通常不具备保持头部直立所必需的颈部肌肉张力（或潜在的肌肉张力）。在没有外部支撑的情况下，头部会向胸部、侧面或背后倾斜。这会带来其他并发症，如流口水和无法保持正常的凝视，并抑制孩子探索世界的能力，导致发育迟缓。目前的治疗方法是用缆绳和头带将儿童的头部从刚性支架上悬挂起来。这种刚性悬架只能提供一个被动水平的支持；根据佩戴者的需要，它能支撑头部的程度很难改变。虽然这确实有助于消除一些不良头部姿势的症状和并发症，但它无助于帮助孩子学会通过自己的肌肉力量来控制他们的头部。它还禁止孩子在想要的时候把头朝特定的方向移动。这项研究汇集了训练有素的治疗师和工程师，他们将调查是否帮助孩子从难以做到的位置抬起他们的头（例如，头部向后倾斜或靠在肩膀上），并在孩子自己支撑头部更容易的地方提供较少的帮助，这将促进孩子对头部的独立控制，随着时间的推移，对支持的需求减少。研究人员将测量悬挂装置提供的辅助量，构建一个计算机模型，识别需要最多支撑的头部姿势，以及颈部肌肉如何支撑头部，并构建一个悬挂装置，该装置可以根据治疗师的输入和计算机模型的预测来编程提供不同程度的支持。小灯塔（Little Light House）是位于美国塔尔萨（Tulsa）的一个为肌肉张力基础较低的有特殊需要的儿童设立的发展中心，那里的孩子们将定期使用这种设备。他们将被评估，以确定对头部的不同支持在多大程度上促进了儿童发展肌肉控制能力的能力，而肌肉控制能力是独立支撑头部所必需的。外展活动将对塔尔萨大学本科生进行，他们参与了Make A Difference Engineering (MADE at TU)，这是一个致力于利用工程技能满足残疾人需求的学生团体。这个小组的学生将参与项目的非安全关键方面。这将教育他们有关康复工程研究，并为他们在这一重要领域的研究生学习和职业生涯做好准备。该项目包括三个目标，以支持开发一个系统，为低张力患者提供动态头颈部支持的总体目标。首先，将开发一个颈部的生物力学模型，该模型将整合为正常人提供适当头部支撑的肌肉。这个模型将进一步发展，以解释由于张力不足和头部支撑的影响而引起的变化。其次，该模型将在有头部支撑的低渗条件下进行验证。最后，一种主动的、动态的头部支撑装置将被开发出来，它可以对头部的姿势、个人的意图和治疗师的输入做出反应，以促进颈部肌肉的加强，提高个人的生活质量。该模型将发展到功能准确，包括适当的肌肉，以充分模拟颈部维持头部姿势的功能，并解释低张力个体反应的差异。它将在OpenSim中开发，结合尸体、放射学和体内研究，并与物理治疗师合作进行测量验证。该装置将在临床环境中进行评估，以确定它是否支持加强颈部的康复目标，并随着时间的推移允许更多独立的头部支持。

Children with certain developmental disabilities often do not possess the muscle tone (or underlying muscle tension) in the neck necessary to hold their heads erect. Without external support, the head falls to the chest, to the side, or behind them. This brings about other complications, such as drooling and inability to maintain normal gaze, and inhibits the child's ability to explore the world, causing developmental delays. The current therapeutic practice is to suspend the child's head from a rigid support using a cable and head strap. This rigid suspension can only provide one passive level of support; how much it helps to hold up the head cannot be easily modified in response to the wearer's needs. While this does help eliminate some of the symptoms and complications of poor head posture, it does nothing to help the child learn to control their head by their own muscle power. It also prohibits the child from moving their head in certain directions when desired. This research brings together trained therapists and engineers who will investigate whether assisting the child to raise their head from positions where it is difficult to do so (e.g. with the head tilted far forward, back, or resting on the shoulder), and providing less assistance where it is easier for the child to support the head on their own will promote developing independent control of the head, with less need for support over time. Researchers will measure the amount of assistance being provided by the suspension device, construct a computer model that identifies head poses requiring the most support and how the neck muscles work to support the head, and build a suspension device that can be programmed with different levels of support provided based on therapist input and the predictions of the computer model. Children at the Little Light House, a development center for children with special needs in Tulsa, OK who have low muscle tone base, will use the device on a regular basis. They will be assessed to determine how well varying the support provided to the head promotes the child's ability to develop the muscular control needed to hold up their head independently. Outreach activities will be conducted to University of Tulsa undergraduate students involved in Make A Difference Engineering (MADE at TU), a student group dedicated to using engineering skills to meet the needs of disabled persons. Students from this group will be involved in non-safety-critical aspects of the project. This will educate them about rehabilitation engineering research and prepare them for graduate study and careers in this important area.This project includes three objectives to support the overall goal of developing a system to provide dynamic head/neck support for individuals with hypotonia. First, a biomechanical model of the neck will be developed that will integrate the muscles that provide appropriate head support in normal individuals. This model will then be further developed to account for changes due to hypotonia and the effect of a head support. Second, the model will be validated for hypotonic conditions in the presence of a head support. Finally, an active, dynamic head support device will be developed that can respond to the pose of the head, an individual's intent, and therapist input to promote strengthening of the neck muscles and an improved quality of life for the individual. The model will be developed to be functionally accurate, including appropriate muscles to fully model the function of the neck in maintaining head posture and account for differences in the response of hypotonic individuals. It will be developed in OpenSim using a combination of cadaveric, radiographic, and in vivo studies and validated against measurements made in collaboration with physical therapists. The device that is developed will be evaluated in a clinical setting to determine if it supports the rehabilitative goals of strengthening the neck and allowing more independent head support over time.