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A novel mechanics-based intervention to improve post-stroke gait stability

一种新颖的基于力学的干预措施可改善中风后步态稳定性

基本信息

批准号：
10183188
负责人：
JESSE C. DEAN
金额：
--
依托单位：
RALPH H JOHNSON VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-01-01 至 2021-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10183188
关键词：
Acute Address Adult American Body Weight Caring Characteristics Clinical Communities Data Development Devices Effectiveness Elements Engineering Environment Equilibrium Evidence based intervention Failure Fall prevention Foundations Future Gait Goals Human Incidence Individual Intervention Investigation Knowledge Leg Link Location Locomotor training Measures Mechanics Methods Mind Motion Movement Neurologic Neuromechanics Participant Patients Pattern Population Positioning Attribute Quality of life Rehabilitation device Rehabilitation therapy Research Robot Speed Stroke Techniques Testing Therapeutic Intervention Time Veterans Walking Work active control base clinical implementation cost estimate design dosage experience experimental study fall risk falls fear of falling follow-up foot gait rehabilitation improved intervention effect kinematics motor control motor learning new technology novel patient subsets post stroke prevent prototype rehabilitation paradigm response restoration robot assistance robot rehabilitation robotic device stroke intervention stroke survivor success systematic review treadmill walking speed

项目摘要

Independent mobility, the ability of an individual to successfully and safely navigate through their environment, is a primary contributor to quality of life. Unfortunately, mobility often decreases following a stroke, preventing many stroke survivors from returning to typical levels of activity participation. A major contributor to reduced mobility is gait instability, which can limit function either by increasing the risk of falls or by increasing the fear of falling. Several existing rehabilitation techniques have been demonstrated to improve certain aspects of post-stroke gait function, such as increasing self-selected walking speed. However, these interventions have generally failed to address gait instability, as evidenced by a lack of improvement in fall risk. A likely reason for the limited effectiveness of current rehabilitation approaches is that they are not based on the unique mechanisms underlying post-stroke gait instability. A longer-term goal of this general line of research is to develop clinically-available, mechanism-based interventions to improve post-stroke gait stability. As a step toward accomplishing this goal, the project will focus on a potential mechanistic cause of instability suggested by preliminary work investigating how gait is stabilized among uninjured controls and stroke survivors. This approach contrasts with typical investigations of gait instability, which largely focus on quantifying non-causal indicators of stability rather than understanding the underlying mechanisms. The central hypothesis is that post-stroke disruptions in gait stability are often caused by a lack of mechanically-appropriate adjustments in foot placement location. While individuals with stable gait patterns actively control their foot placement based on the mechanical state of their center of mass, this evidence of active stabilization is often lacking after a stroke. The disruption of the typical gait stabilization strategy has motivated the recent construction of a prototype rehabilitation robotics device able to manipulate foot placement location. The objective of this proposal is to further develop this device and conduct initial testing of its ability to improve post-stroke gait stability, based on principles of motor learning. This will be accomplished through three Specific Aims. The first Specific Aim is to identify the simplest force-field control method able to effectively modulate foot placement. Several candidate control methods will be compared in terms of their ability to increase mechanically-appropriate foot placement modulation. The second Specific Aim is to determine whether the typical gait stabilization strategy can be restored by repeated gait practice while the force-field either: 1) encourages mechanically-appropriate foot placement; or 2) amplifies errors away from mechanically- appropriate target locations. These two intervention strategies are based on distinct theoretical frameworks. The “challenge point framework” suggests that mechanical assistance provided by the force-field may allow stroke survivors to experience (and relearn) a movement pattern they may otherwise be unable to accomplish. In contrast, the “error-driven adaptation” framework suggests that amplified kinematic errors may drive participants to actively resist these forces, producing beneficial after-effects in foot placement. The third Specific Aim will quantify the effects of patient baseline characteristics and dosage on the intervention’s effects, necessary data for future larger-scale trials. The proposed project is based on the combined theoretical frameworks of human gait mechanics and motor learning, and will quantify the potential of mechanism-based interventions using a novel force-field to restore the typical neuromechanical gait stabilization strategy in stroke survivors. The resultant knowledge has the potential to make an important contribution to the development of a larger-scale rehabilitation paradigm in which therapeutic interventions are targeted to a patient’s specific limitations.

独立移动性，个人成功和安全地在其环境中导航的能力，是生活质量的主要贡献者。不幸的是，中风后活动性通常会降低，许多中风幸存者恢复到典型的活动参与水平。一个主要原因是，活动性是步态不稳，它可以通过增加福尔斯的风险或增加恐惧来限制功能掉下去。已经证明了几种现有的康复技术可以改善某些方面的健康状况。中风后步态功能，如增加自选步行速度。然而，这些干预措施通常未能解决步态不稳，如跌倒风险缺乏改善所证明的。可能的原因目前康复方法的有限有效性在于它们不是基于独特的中风后步态不稳的潜在机制。这项研究的长期目标是开发临床可用的，基于机制的改善中风后步态稳定性的干预措施。作为实现这一目标的一步，该项目将重点关注研究步态如何变化的初步工作提出的不稳定的潜在机械原因在未受伤的对照组和中风幸存者中稳定。这种方法与典型的步态不稳，主要侧重于量化稳定性的非因果指标，而不是了解根本机制。中心假设是中风后步态稳定性的破坏通常是由于缺乏在足部放置位置上进行机械上适当的调整。而步态稳定的人主动控制他们的脚放置的基础上，他们的质心的机械状态，这一证据，中风后常常缺乏主动稳定。典型步态稳定策略的中断促使最近建造了一个原型康复机器人设备，能够操纵脚放置位置。本提案的目的是进一步开发该设备，并进行初步测试，它的能力，以改善中风后步态的稳定性，基于运动学习的原则。这将是完成三个具体目标。第一个具体目标是确定最简单的力场控制方法，能够有效地调节脚安置将比较几种候选控制方法的能力，机械上适当的足部放置调节。第二个具体目标是确定典型的步态稳定策略可以通过重复的步态练习来恢复，而力场：1）鼓励机械适当的脚放置;或2）放大错误远离机械- 合适的目标位置。这两种干预策略基于不同的理论框架。 "挑战点框架"表明，力场提供的机械协助可能允许中风幸存者体验（并重新学习）他们可能无法完成的运动模式。相反，"错误驱动的适应"框架表明，放大的运动学错误可能会驱动参与者积极抵抗这些力量，在足部放置中产生有益的后效。第三具体目标将量化患者基线特征和剂量对干预的影响。为未来更大规模的试验提供必要的数据。该项目基于人体步态力学和运动学的综合理论框架学习，并将量化的潜力机制为基础的干预使用一种新的力场，以恢复中风幸存者的典型神经机械步态稳定策略。由此产生的知识有可能为发展大规模的康复模式作出重要贡献，哪些治疗干预是针对患者的特定局限性的。