Robotic Orthoses for Gait Rehabilitation

描述(申请人提供)：我们开发了一种可以帮助人类行走的电动脚踝-足部矫形器。踝足矫形器有一个人工气动肌肉，根据比目鱼肌的激活提供足底屈肌扭矩(即比例肌电控制)。我们将重点放在机器人对脚踝的辅助上，因为站立时的足底屈曲是行走过程中机械动力的主要来源，并与神经残疾患者的行走能力直接相关。佩戴矫形器的神经学完好的受试者迅速调整他们的肌肉激活模式，以补偿矫形器提供的额外机械动力。我们建议确定不完全脊髓损伤的受试者是否从使用电动矫形器的步行练习中受益。我们的初步数据表明，比例肌电控制为重塑不完全脊髓损伤受试者的肌肉激活模式提供了强大的刺激。矫形器有效地使肌肉变得更强壮。这为神经系统提供了增强的本体感觉反馈，将肌肉招募与关节运动联系起来。这种创新的方法是独一无二的，因为其他机器人康复设备依赖外部代理(即计算机)来控制机械辅助的时间和大小，而不是我们建议的患者自己的神经系统。我们将在使用矫形器练习步行8周之前和之后，测量不完全脊髓损伤患者的H反射、肌电、运动学、动力学和代谢成本。这一结果将为设计动力矫形器的扩展随机临床试验提供足够的数据。公共卫生相关性：我们将研究腿上戴着机器人支架行走的不完全脊髓损伤患者，以确定支架是否可以提高他们的行走能力。这一结果可能会导致新的机器人疗法，以改善脊髓损伤或中风后的康复。

DESCRIPTION (provided by applicant): We have developed a powered ankle-foot orthosis that can assist human walking. The ankle-foot orthosis has an artificial pneumatic muscle providing plantar flexor torque in response to soleus muscle activation (i.e. proportional myoelectric control). We focus on robotic assistance for the ankle because plantar flexion during stance is a major source of mechanical power during walking and is directly related to walking ability in individuals with neurological disability. Neurologically intact subjects wearing the orthoses rapidly adapt their muscle activation patterns to compensate for the added mechanical power provided by the orthoses. We propose to determine if subjects with incomplete spinal cord injury benefit from practice walking with the powered orthoses. Our preliminary data suggest that proportional myoelectric control provides a powerful stimulus for re-shaping muscle activation patterns in subjects with incomplete spinal cord injury. The orthosis effectively makes the muscle stronger. This provides the nervous system with enhanced proprioceptive feedback linking muscle recruitment to joint motion. This innovative approach is unique as other robotic rehabilitation devices rely on an external agent (i.e. a computer) to control the timing and magnitude of mechanical assistance rather than the patient's own nervous system as we propose. We will measure H-reflexes, electromyography, kinematics, kinetics, and metabolic cost in individuals with incomplete spinal cord injury before and after eight weeks of practice walking with the orthoses. The results will provide sufficient data to design an extended randomized clinical trial of the powered orthosis. PUBLIC HEALTH RELEVANCE: We will study people with incomplete spinal cord injury walking with robotic braces on their legs to determine if the braces can improve their walking ability. The results may lead to new robotic therapies for improving rehabilitation after spinal cord injury or stroke.