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

步行是一项基本的日常活动，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性行走，被认为是独立的社区步行车。许多中风患者有不对称的行走方式（例如，每条腿的步长不同），这降低了行走效率，降低了行走速度，增加了受伤和跌倒的可能性。为了感受不对称的步态，你可以试着一只脚穿厚底的厚鞋，另一只脚赤脚；然后试着每只脚以相同的步长行走，同时保持每只脚着地的时间一致。这种简单的扰动可能会改变步态，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一个都有多个不对称的变化，这些变化叠加了有害的影响。虽然有许多不同的治疗方法可以帮助个人恢复行走能力，但残疾是独特的，通常需要针对每个人的具体解决方案。该项目将同时使用现有疗法的组合，以产生适应个人需求的用户特定疗法。该项目侧重于中风后的步态康复，但可能会对下肢截肢、偏瘫性脑瘫和其他步态障碍患者的步态恢复治疗产生益处。该项目解决了以下研究问题：(i)对于具有固有功能不对称的患者，可能针对的对称水平是多少；（ii）什么因素影响对称步态的感知；（iii）如何对用于康复的多种疗法之间的相互作用进行建模。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在一起的。基于多对同时治疗的结果，第二阶段将使用实时反馈，基于测量的步态来优化两种或更多个体治疗的输出。控制多种疗法应该允许控制多种步态参数，这些参数可以以用户特定的方式改变步态模式。由于中风患者的每条腿天生就有不同的力量和运动能力，完美的对称可能是不可能的。在整个项目中，实验将从视觉角度确定可接受的不对称范围。这种感知将有助于理解临床物理治疗师对步态的感知，并帮助他们关注重要参数，特别是那些对步态功能有很大影响但不易感知的参数。尽管最终的步态在所有测量中都可能有一定程度的不对称，但步态模式可能不太容易在视觉上被注意到，并且满足不对称损伤个体的功能性步行目标。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值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.