Maneuverability Enhancement Following Spinal Cord Injury

 描述（由申请人提供）： 项目概述：我们需要制定有效的干预措施，以加强不完全性脊髓损伤（iSCI）的退伍军人的努力，以恢复不受限制的社区援助所需的动态平衡。该提案旨在了解iSCI患者在演习期间如何稳定，并创建机器人环境，以促进演习的主动或被动稳定。这项研究将促进我们对改善动态平衡所需解决的障碍以及如何优化训练干预以有效提高稳定性的理解。研究者：我们的领导团队由生物力学家，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具有丰富的经验。Gordon博士和Kahn博士分别从神经力学和临床角度研究脊髓损伤后的步态康复。戈登博士最近的重点是机器人设备的开发，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。工作环境：拟议的研究项目将在位于西北大学物理治疗和人类运动科学系（PTHMS）内的人类敏捷实验室内的VA租赁空间进行。PTHMS提供的资源包括专用的研究空间和设备、临床检查区域、办公空间和机械车间。iSCI退伍军人的主要招募将通过Edward Hines Jr的脊髓损伤服务进行。退伍军人医院拟议的研究：目的1）量化iSCI患者在演习期间稳定的机制。我们将量化与稳定性和可操作性相关的几个生物力学因素，因为iSCI患者在以首选和最大速度在地面行走期间执行“换道”操作。这项研究的结果将首次对iSCI患者在行走时如何改变方向进行生物力学评估。这一信息将有助于建立一个理论框架，以设计干预措施，解决这一群体的具体缺陷和需求。目的2）开发机器人环境，促进和加强在运动机动过程中使用主动稳定策略。我们将研究两种新的方法，以鼓励实践的积极机制的稳定在步行演习，通过创建机器人辅助训练环境，无论是稳定或不稳定的个人，因为他们走。改变稳定性的要求将鼓励在机动飞行中实践不同的稳定性机制。这一目标的结果将提供一个明确的评估，如何机器人干预可以操纵，以鼓励积极的机制，以稳定演习的做法。这一信息对于设计有针对性的干预措施以加强流动性至关重要。影响：我们相信，确定方法来提高iSCI患者利用积极的稳定机制的能力，将大大改善动态平衡。这是困难的，因为iSCI患者高度依赖于被动的稳定机制，其存在会干扰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，以便个人能够体验，实践和学习主动的稳定机制。这种方法与目前的做法截然不同，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.