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.

独立的移动性，个人成功安全地通过环境导航的能力，是生活质量的主要因素。不幸的是，行动性经常在中风后降低，阻止许多中风从返回典型的活动参与水平。减少的主要贡献者流动性正在获得不稳定性，这可以通过增加跌倒风险或增加恐惧来限制功能跌倒。已经证明了几种现有的康复技术可以改善中风后步态功能，例如提高自我选择的步行速度。但是，这些干预措施有通常无法解决焦油不稳定，这证明了跌倒风险的改善。可能的原因当前的康复方法的有限有效性是它们不是基于独特的冲程后疾病的基础机制。这项一般研究线的长期目标是开发基于临床的，基于机制改善冲程后疾病的干预措施。作为实现这一目标的一步，该项目将专注于初步工作建议步态的潜在机械原因在未受伤的对照和中风存活中稳定。这种方法与对步态不稳定性，很大程度上要着重于量化稳定的非因果指标而不是理解基本机制。中心假设是，势头稳定中的势后中断通常是由于缺乏在脚部放置位置进行机械适当的调整。而稳定的人会满足模式根据其质量中心的机械状态积极控制其足部位置，这证明了中风后通常缺乏主动稳定。典型的抓地稳定策略的破坏具有激发了最近的原型康复机器人设备能够操纵脚的构建放置位置。该建议的目的是进一步开发此设备并进行初始测试基于运动学原理，它改善后击后养生的能力。这将完成通过三个特定目标。第一个具体目的是确定最简单的力场控制方法可以有效调节脚放置。将根据其增加的能力比较几种候选控制方法机械适合的脚部放置调制。第二个具体目的是确定是否典型的步态稳定策略可以通过反复的步态练习来恢复，而力场也可以：1）鼓励机械适合的脚部放置；或2）放大器偏离机械的错误 - 适当的目标位置。这两种干预策略基于不同的理论框架。 “挑战点框架”表明，力场提供的机械援助可能允许中风生存能体验（并知道）一种运动模式，否则他们可能无法完成。相比之下，“错误驱动改编”框架表明放大运动错误可能会驱动参与者积极抵抗这些力量，从而在脚部放置时产生有益的后效应。第三具体目标将量化患者基线特征和剂量对干预的影响效果，未来大规模试验的必要数据。拟议的项目基于人步态力学和运动的合理理论框架学习，并将使用新型力场恢复基于机制的干预措施的潜力中风存活中典型的神经力学GIT稳定策略。由此产生的知识具有有可能为发展大规模康复范式的发展做出重要贡献哪些治疗干预措施针对患者的特定限制。