Maneuverability Enhancement Following Spinal Cord Injury

 描述(由申请人提供)： 项目概述：我们需要开发有效的干预措施，以加强不完全脊髓损伤(ISCI)退伍军人的努力，以恢复不受限制的社区步行所需的动态平衡。这项建议旨在了解患有ISCI的个体如何在机动过程中保持稳定，并创造有利于练习主动或被动稳定机动的机器人环境。这项研究将促进我们对需要解决的损害的理解，以改善动态平衡，以及如何优化训练干预以有效地提高稳定性。研究人员：我们的领导团队由生物机械师、工程师、临床医生和统计学家组成，在拟议研究的所有关键方面都有丰富的经验。戈登博士和卡恩博士的经验主要集中在脊髓损伤后的步态康复方面，分别从神经力学和临床角度进行。戈登博士最近一直专注于机器人设备的开发，以评估和训练运动稳定性。黄博士在研究使用康复机器人设备促进运动学习和适应方面拥有丰富的经验。环境：拟议的研究项目将在西北大学物理治疗系和人类运动科学系(PTHMS)内的人类敏捷性实验室内的退伍军人事务部租用的空间内进行。PTHMS提供的资源包括专门的研究空间和设备、临床检查区域、办公空间和一个机械车间。ISCI退伍军人的初级招募将通过小Edward Hines Jr.的脊髓损伤服务处进行。退伍军人医院。建议研究：目的1)量化ISCI患者在动作过程中稳定状态的机制。我们将量化几个与稳定性和机动性相关的生物力学因素，当ISCI患者以首选和最大速度在地面上行走时进行“换道”动作。这项研究的结果将提供第一个关于ISCI患者如何在行走时改变方向的生物力学评估。这些信息将有助于建立一个理论框架，以设计针对这一群体的具体赤字和需求的干预措施。目的2)开发机器人环境，促进和加强在运动动作中使用主动稳定策略。我们将研究两种新的方法来鼓励在步行动作中练习主动稳定机制，方法是创建机器人辅助训练环境，以稳定或破坏个人行走时的稳定。改变稳定的要求将鼓励在演习中实行不同的稳定机制。这一目标的结果将提供一个明确的评估，即如何操纵机器人干预，以鼓励采用主动机制来稳定机动。这些信息对于设计有针对性的干预措施以提高机动性至关重要。影响：我们认为，确定提高ISCI患者利用积极稳定机制的能力的方法将极大地改善动态平衡。这是困难的，因为患有ISCI的人高度依赖被动的稳定机制，这些机制的存在干扰了训练主动机制的尝试。我们训练动态平衡的方法是使用机器人环境来抑制被动的稳定机制，这样个人就会对体验、实践和学习主动的稳定机制持开放态度。这种做法从根本上背离了目前的做法，可能会对ISCI患者获得动态平衡能力的能力产生重大影响。

 DESCRIPTION (provided by applicant): Project Overview: We need to develop effective interventions to enhance the efforts of veterans with incomplete spinal cord injury (iSCI) to recover the dynamic balance needed for unrestricted community ambulation. This proposal aims to understand how individuals with iSCI stabilize during maneuvers and to create robotic environments that facilitate practice of either active or passive stabilization of maneuvers. This research will advance our understanding of the impairments that need to be addressed to improve dynamic balance and how to optimize training interventions to effectively improve stability. Investigators: Our leadership team composed of a biomechanist, engineer, clinician and statistician has significant experience in all the crucial aspects of the proposed research. Dr. Gordon and Dr. Kahn's experience centers on gait rehabilitation following spinal cord injury from neuromechanics and clinical perspectives respectively. Dr. Gordon's recent focus has been on the development of robotic devices to assess and train locomotor stability. Dr. Huang has significant experience investigating the use of rehabilitation robotic devices to foster motor learning and adaption. Environment: The proposed research project will be conducted in VA leased space within the Human Agility Laboratory located within the Northwestern University Department of Physical Therapy and Human Movement Sciences Department (PTHMS). The resources provided by PTHMS include dedicated research space and equipment, clinical examination areas, offices space and a machine shop. Primary recruitment of veterans with iSCI will be performed through the Spinal Cord Injury Service at Edward Hines Jr. VA Hospital. Proposed Research: Aim 1) To quantify the mechanisms used by individuals with iSCI to stabilize during maneuvers. We will quantify several biomechanical factors related to stability and maneuverability as people with iSCI perform a "lane-change" maneuver during over ground walking at preferred and maximum speeds. Outcomes from this research will provide the first biomechanical assessment of how individuals with iSCI change direction while walking. This information will be valuable for creating a theoretical framework for designing interventions that address the specific deficits and needs of this population. Aim 2) To develop robotic environments that promote and reinforce the use of active stabilization strategies during locomotor maneuvers. We will investigate two novel approaches to encourage practice of active mechanisms of stabilization during walking maneuvers by creating robotic assisted training environments that act to either stabilize or destabilize individuals as they walk. Altering the requirements of stabilization will encourage practice of different mechanisms of stability during maneuvers. Outcomes from this aim will provide a clear assessment of how robotic interventions can be manipulated to encourage practice of active mechanisms to stabilize maneuvers. This information will be crucial for designing targeted interventions to enhance mobility. Impact: We believe that identifying methods to enhance the ability of individuals with iSCI to utilize active mechanisms of stability will substantially improve dynamic balance. This is difficult because individuals with iSCI are highly dependent on passive mechanisms of stability whose presence interferes with attempts to train active mechanisms. Our approach to training dynamic balance is to use robotic environments to suppress passive mechanisms of stability so that individuals will become open to experience, practice and learn active mechanisms of stability. This approach is a radical departure from current practice and may have a substantial impact on the ability of individuals with iSCI to acquire dynamic balance capabilities.