Noninvasive assessment of in vivo tissue loads to enhance the treatment of gait disorders

对体内组织负荷进行无创评估，以加强步态障碍的治疗

• 批准号: 10187614
• 负责人: DARRYL G THELEN
• 金额: $ 29.43万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10187614
• 关键词: Accelerometer; Ankle; Behavior; Biomechanics; Cadaver; Cerebral Palsy; Child; Childhood; Clinical; Clinical Treatment; Contracture; Data; Databases; Deformity; Diagnosis; Dorsal; Dyskinetic syndrome; Exertion; Exhibits; Fatigue; Freedom; Freezing; Frequencies; Gait; Gait abnormality; Geometry; Goals; Human; Image; Impairment; In Vitro; Individual; Isometric Exercise; Isotonic Exercise; Joints; Kinetics; Knee; Lead; Leg; Lower Extremity; Measurement; Measures; Mechanics; Methods; Modeling; Monitor; Movement; Movement Disorders; Muscle; Orthopedic Surgery; Outcome; Outcome Assessment; Outcome Study; Pain; Pathologic; Patients; Pattern; Pharmaceutical Preparations; Positioning Attribute; Procedures; Proxy; Reaction; Research; Rhizotomy procedure; Robotics; Signal Transduction; Skin; Spastic Cerebral Palsy; Specimen; Speed; Standardization; Stress; System; Technology; Tendon force; Tendon structure; Testing; Time; Tissues; Toes; Torque; Treatment outcome; Walking; base; crouch gait; design; equinus gait; foot; gait examination; hamstring; human subject; in vitro Model; in vivo; joint loading; kinematics; motor control; novel; prototype; spasticity; tibialis anterior muscle; treatment planning; vibration; walking speed

Abstract The long-term goal of this research is to use in vivo muscle-tendon force measurements to enhance the clinical treatment of gait disorders in individuals with cerebral palsy (CP). We have recently shown that the frequency at which a tendon vibrates is dependent on the applied stress. This phenomenon is similar to the tension-dependent vibration seen in guitar strings. Vibration frequency reflects the speed at which transverse, or shear, waves propagate. Hence, it may be feasible to monitor shear wave speed in tendon as a proxy for tissue loading. This study will investigate the potential to measure and interpret shear wave speeds in human tendons. The initial two aims are designed to investigate the validity and robustness of the relationship between shear wave speed and tendon loading. Skin-mounted tensiometers will be designed that induce and track propagating shear waves of micron-scale amplitude. Cadaveric ankle-foot specimens will be tested in aim 1. A robotic gait simulator will drive external foot and internal tendon loading to emulate human walking. Tendon tensions and wave speeds will be simultaneously monitored. Human subjects will be tested in Aim 2. Tensiometers positioned over superficial knee and ankle tendons will monitor wave speeds while subjects perform isometric and isokinetic exertions. Data from aims 1 and 2 will be used to investigate how subject- and tendon-specific geometry can modulate the relationship between tendon wave speed and load. The final two aims will use tensiometers to measure shear wave speeds in the superficial leg tendons during walking. Typically developing children will be tested in Aim 3 to establish a normative database of wave speed patterns over a gait cycle. Individuals with CP who exhibit either equinus (toe-walking) or crouch (flexed knee) will be tested in Aim 4. Tendon wave speed measures will be obtained while subjects are undergoing a standard clinical gait analysis. We will explore clinical utility by performing direct comparisons between shear wave speed data, joint kinetics, EMG signals and clinical interpretations based on traditional gait analysis. The anticipated outcome of this study is a ground-breaking approach to assess in vivo muscle-tendon loads during both normal and pathological gait. Successful completion of the aims could lead to enhanced diagnosis and outcomes assessment of gait disorders.

摘要 这项研究的长期目标是使用体内肌肉肌腱力测量来增强 脑瘫患者步态障碍的临床治疗。我们最近的研究表明 钢筋束振动的频率取决于所施加的应力。这种现象 类似于在吉他弦中看到的张力依赖性振动。振动频率反映速度 横波或剪切波传播的位置。因此，监测剪切波速是可行的 作为组织负荷的代表。本研究将探讨测量和解释 剪切波速度在人体肌腱。 最初的两个目标是为了研究有效性和鲁棒性之间的关系， 剪切波速度和钢筋束载荷。皮肤安装的张力计将被设计为诱导和 跟踪微米级振幅的传播剪切波。将对尸体踝足标本进行测试 在目标1中。机器人步态模拟器将驱动外部脚和内部肌腱加载，以模仿人类 走路同时监测钢筋束张力和波速。人类受试者将 目标2测试将张力计放置在浅表膝关节和踝关节肌腱上，监测波 速度，而受试者进行等长和等速运动。目标1和2的数据将用于 研究受试者和肌腱特定几何形状如何调节肌腱之间的关系， 波浪速度和载荷。最后两个目标将使用张力计来测量剪切波的速度， 行走时的腿部浅肌腱。在目标3中，将对发育正常的儿童进行测试， 步态周期内的波速模式的规范数据库。患有CP的个人， 将在目标4中测试马蹄足（脚趾行走）或蹲伏（膝关节屈曲）。腱波速度测量将 在受试者进行标准临床步态分析时获得。我们将探索临床 通过在剪切波速度数据、关节动力学、EMG信号之间进行直接比较， 和基于传统步态分析的临床解释。 这项研究的预期结果是一个突破性的方法来评估体内肌肉肌腱 在正常和病理步态期间的负载。成功实现这些目标可导致 增强步态障碍的诊断和结局评估。

项目成果

American Society of Biomechanics Clinical Biomechanics Award 2021: Redistribution of muscle-tendon work in children with cerebral palsy who walk in crouch.

2021 年美国生物力学学会临床生物力学奖：蹲伏行走的脑瘫儿童的肌肉肌腱工作重新分配。

• DOI: 10.1016/j.clinbiomech.2023.105871
• 发表时间: 2023
• 期刊: Clinical biomechanics (Bristol, Avon)
• 作者: Ebrahimi,Anahid;Martin,JackA;Schwartz,MichaelH;Novacheck,TomF;Thelen,DarrylG
• 通讯作者: Thelen,DarrylG

Normative Achilles and patellar tendon shear wave speeds and loading patterns during walking in typically developing children.

• DOI: 10.1016/j.gaitpost.2021.05.023
• 发表时间: 2021-07
• 期刊: Gait & posture
• 影响因子: 2.4
• 作者: Ebrahimi A;Kuchler RL;Pomeroy RL;Loegering IF;Martin JA;Thelen DG
• 通讯作者: Thelen DG

Atypical triceps surae force and work patterns underlying gait in children with cerebral palsy.

• DOI: 10.1002/jor.25307
• 发表时间: 2022-12
• 期刊: JOURNAL OF ORTHOPAEDIC RESEARCH
• 影响因子: 2.8
• 作者: Ebrahimi, Anahid;Schwartz, Michael H.;Martin, Jack A.;Novacheck, Tom F.;Thelen, Darryl G.
• 通讯作者: Thelen, Darryl G.

A trained neural network model accurately predicts Achilles tendon stress during walking and running based on shear wave propagation.

经过训练的神经网络模型根据剪切波传播准确预测步行和跑步期间的跟腱应力。

• DOI: 10.1016/j.jbiomech.2023.111699
• 发表时间: 2023
• 期刊: Journal of biomechanics
• 影响因子: 2.4
• 作者: Martin,JackA;Thelen,DarrylG
• 通讯作者: Thelen,DarrylG