OpenSim Enhancements to Enable Computational Design of Personalized Treatments for Movement Impairments

摘要 骨关节炎、中风、脊髓损伤、创伤性脑损伤和截肢影响了大约19%的美国人。 成人人群，骨关节炎和中风是成人严重长期残疾的主要原因 国际吧沿着其他疾病，如脑瘫、帕金森病和骨科癌症， 这些疾病通常严重损害运动，导致巨大的社会成本， 其他严重的健康状况（例如，心脏病和糖尿病），减少甚至丧失独立性， 生活质量下降。尽管问题的重要性和每个病人的独特性， 运动障碍的治疗设计尚未取得实质性进展， 根据主观临床判断选择干预措施。如果受影响的人要恢复最多 功能可能，需要向使用目标设计的个性化干预措施进行范式转变 循证方法。 该项目旨在开发创新的软件技术，使工程师能够在 与临床医生合作，设计针对运动障碍的有效个性化干预措施， 基于客观物理的计算机模型。软件技术将采用相同的计算机建模 在过去25年里， 年拟议的软件将创建患者的虚拟表示，然后应用虚拟 治疗，以确定最有可能最大限度地恢复损失的治疗设计。 功能虚拟患者模型将遵守物理定律和生理学原理，以反映患者如何 在治疗前移动，并预测患者在治疗后将如何移动。为了实现快速和轻松 构建患者模型和优化患者功能结果，软件技术将 它被整合到NIH资助的OpenSim软件中，用于人体运动的建模和模拟。 为了支持拟议软件的开发和采用，该项目还将使用该软件来 为三名中风后行走功能受损、不对称的患者设计个性化干预措施。 研究小组将举办为期三年的“中风大挑战赛”，每年在 同样的专业会议，让研究界参与基于模型的个性化治疗 设计将从每个受试者收集大量的人体运动数据集，用于构建 一个虚拟的模型相互竞争的研究团队将使用该软件和主题的虚拟模型 来设计个性化的治疗方法来改善受试者行走的对称性。此外，研究团队 将使用新软件为相同的受试者开发自己的个性化干预设计。任何 由竞赛参与者或研究团队确定的有临床前景的干预措施将被 在后续项目中对相同的受试者实施，以评估其疗效。

Abstract Osteoarthritis, stroke, spinal cord injury, traumatic brain injury, and amputation affect roughly 19% of the U.S. adult population, with osteoarthritis and stroke being leading causes of serious long-term disability in adults worldwide. Along with other conditions such as cerebral palsy, Parkinson's disease, and orthopedic cancer, these conditions often significantly impair movement, resulting in substantial societal costs, an increased risk of other serious health conditions (e.g., heart disease and diabetes), a reduction or even loss of independence, and a decreased quality of life. Despite the significance of the problem and the uniqueness of each patient, treatment design for movement impairments has not progressed substantially beyond off-the-shelf interventions selected based on subjective clinical judgment. If affected individuals are to recover the most function possible, a paradigm shift is needed toward personalized interventions designed using objective evidence-based methods. This project seeks to develop innovative software technology that will allow engineers working in collaboration with clinicians to design effective personalized interventions for movement impairments using objective physics-based computer models. The software technology will employ the same computer modeling and simulation methods that have revolutionized the design of airplanes and automobiles over the past 25 years. The proposed software will create a virtual representation of the patient and then apply virtual treatments to the virtual patient to identify the treatment design that is most likely to maximize recovery of lost function. Virtual patient models will obey laws of physics and principles of physiology to reflect how the patient moves before treatment and predict how the patient will move after treatment. To enable fast and easy construction of patient models and optimization of patient functional outcomes, the software technology will be incorporated into the NIH-funded OpenSim software for modeling and simulation of human movement. To support development and adoption of the proposed software, the project will also use the software to design personalized interventions for three individuals post-stroke with impaired, asymmetric walking function. The research team will organize a three-year “Stroke Grand Challenge Competition,” held each year at the same professional conference, to engage the research community in model-based personalized treatment design. An extensive human movement data set will be collected from each subject to be used for constructing a virtual model of the subject. Competing research teams will use the software and the subject's virtual model to design personalized treatments that improve the subject's walking symmetry. In addition, the research team will use the new software to develop its own personalized intervention designs for the same subjects. Any clinically promising interventions identified by either competition participants or the research team will be implemented on the same subjects in a follow-on project to evaluate their efficacy.