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。 成人人口，骨关节炎和中风是导致成人长期严重残疾的主要原因 全世界。与脑瘫、帕金森氏症和骨科癌症等其他疾病一起， 这些情况往往严重损害行动，导致大量的社会成本，增加风险 其他严重的健康状况(如心脏病和糖尿病)，降低或甚至丧失独立性， 以及生活质量的下降。尽管问题的严重性和每个患者的独特性， 运动障碍的治疗设计在现成的基础上还没有实质性的进展 干预措施的选择基于主观的临床判断。如果受影响的人想要恢复最多 功能是可能的，需要将范式转变为使用目标设计的个性化干预 循证方法。 该项目寻求开发创新的软件技术，使工程师能够在 与临床医生合作，为运动障碍设计有效的个性化干预措施 目的建立基于物理学的计算机模型。软件技术将采用相同的计算机建模 和模拟方法，在过去的25年里彻底改变了飞机和汽车的设计 好几年了。建议的软件将创建患者的虚拟表示，然后应用虚拟 对虚拟患者进行治疗，以确定最有可能最大限度地恢复丢失的治疗设计 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 在治疗前运动，并预测病人在治疗后如何运动。要快速轻松地实现 构建患者模型和优化患者功能结果，软件技术将 集成到NIH资助的OpenSim软件中，用于对人体运动进行建模和模拟。 为支持拟议软件的开发和采用，该项目还将使用该软件 为三个中风后不对称行走功能受损的个体设计个性化的干预措施。 课题组将组织为期三年的“划水大挑战大赛”，每年在 同样的专业会议，让研究社区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，以用于构建 受试者的虚拟模型。相互竞争的研究团队将使用该软件和受试者的虚拟模型 设计个性化的治疗方法，改善受试者行走的对称性。此外，研究小组 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 由参赛者或研究团队确定的具有临床前景的干预措施将是 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.