CHS: Small: Feedback-based Stroke Rehabilitation Using Multiple Simultaneous Therapies

步行是一项基本的日常活动，而独立行走是中风患者的主要目标。然而，只有不到22%的中风患者能够恢复足够的功能行走，被认为是独立的社区救护车。许多中风患者具有不对称的步行模式(例如，每条腿的步长不同)，这降低了步行效率，降低了步行速度，并增加了受伤和摔倒的可能性。为了感受不对称的步态，你可以试着一只脚穿厚底厚重的鞋子，另一只脚赤脚走路；然后试着每只脚走路的步长相同，同时保持每只脚落地的一致时间。这种简单的扰动很可能会改变步态，使人在走路时不得不用一条腿更用力地推。与这个例子中的一个扰动相反，数百万中风患者中的每个人都有多个不对称的变化，这些变化加剧了有害的影响。虽然有许多不同的治疗方法可以帮助个人恢复行走能力，但残疾是独一无二的，通常需要针对每个人的具体解决方案。该项目将使用同时应用的现有疗法的组合来产生适应个人需求的特定于用户的疗法。这个项目专注于中风后的步态康复，但可能会对下肢截肢、偏瘫脑瘫和其他步态障碍患者的步态恢复治疗有所裨益。本项目解决的研究问题包括：(I)具有固有功能不对称的患者的对称性水平是什么；(Ii)影响对称步态感知的因素是什么；(Iii)如何模拟用于康复的多种治疗之间的相互作用。为了回答这些问题，研究小组将首先了解两种不同疗法的效果是如何结合的。基于多对同时治疗的结果，第二阶段将使用基于测量的步态的实时反馈，以优化两个或更多单独治疗的输出。控制多个疗法应该允许控制多个步态参数，这些参数可以以用户特定的方式改变步态模式。由于中风患者每条腿的力量和运动能力天生不同，完美的对称性可能是不可能的。在整个项目中，实验将从视觉角度确定可接受的不对称性的界限。这种感知将有助于了解临床物理治疗师对步态的看法，并有助于将他们的注意力引导到重要参数上，特别是那些对步态功能有很大影响但不易被感知的参数。尽管由此产生的步态在所有指标上都可能有一定程度的不对称性，但步态模式可能在视觉上不那么明显，并满足非对称性障碍个人的功能性步行目标。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

Walking is a fundamental daily activity, and independent walking is a primary goal for individuals with a stroke. However, less than 22% of people with a stroke are able to regain sufficient functional walking to be considered independent community ambulators. Many individuals with a stroke have asymmetric walking patterns (e.g., different step lengths with each leg) that reduce walking efficiency, decrease walking speed, and increase the likelihood of injuries and falls. To get a feel for asymmetric gait, one can try wearing a thick-soled heavy shoe on one foot and go barefoot on the other; then try to walk with the same step length on each foot while maintaining a consistent timing between placing each foot on the ground. This simple perturbation will likely modify the gait such that the person has to push harder with one leg during walking. In contrast to the one perturbation in this example, each of the millions of individuals with a stroke have multiple asymmetric changes that compound the detrimental effects. While there are many different therapies to help individuals regain their walking ability, disabilities are unique and often need a solution specific to each person. This project will use a combination of existing therapies applied simultaneously to generate a user-specific therapy that adapts to the individual's needs. This project focuses on gait rehabilitation after a stroke but may lead to benefits in therapies for gait recovery in individuals with lower limb amputations, hemiparetic cerebral palsy, and other gait impairments.This project addresses research questions such as: (i) what is the level of the symmetry that can potentially be targeted for a patient that has inherent asymmetry in functionality; (ii) what factors influence the perception of a symmetric gait; (iii) how to model the interactions among multiple therapies used for rehabilitation. To answer these questions, the research team will first understand how the effects from two different therapies combine. Based on the results of multiple pairs of simultaneous therapies, the second phase will use real-time feedback, based on the measured gait to optimize the output from two or more individual therapies. Controlling multiple therapies should allow for the control of multiple gait parameters that can change the gait pattern in a user-specific way. Since individuals with a stroke inherently have different force and motion capabilities on each leg, perfect symmetry may not be possible. Throughout this project, experiments will determine the bounds of acceptable asymmetry from a visual perspective. This perception will help understand what clinical physical therapists perceive about gait and help direct their attention to important parameters, particularly those that both have a large impact on gait function but are not easily perceived. Although the resulting gait may have some degree of asymmetry in all measures, the gait pattern will likely be less visually noticeable and meet the functional walking goals of individuals with asymmetric impairments.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.