Development of an Orthosis with an Integrated Microphone for Measurement of Knee Acoustic Emissions in Pre-Radiographic Osteoarthritis

这是康复研究小型项目（SPiRE）奖的申请，授予医学博士大卫·尤尔特（David Ewart），一位 明尼阿波利斯退伍军人医疗中心的风湿病学家和明尼苏达大学的助理教授。 明尼苏达Ewart博士在生物力学、免疫学和动物学方面有着研究和出版的历史。 关节炎模型，并正在过渡到重点治疗和关节损伤的康复。博士 Ewart是一个早期的职业调查员，有保护的时间来建立一个独立的调查线。这 SPiRE奖将为Ewart博士提供以下支持：1）开发独特的机构间合作， 建立一个矫形器与集成麦克风测量声发射从膝盖的点 护理2）使用声发射识别膝关节放射前骨关节炎患者3）建立 在一个忙碌研究小组中担任指导角色，并生成申请职业的初步数据 发展奖（CDA-2）。为了实现这些目标，Ewart博士建立了一个导师团队， 安德鲁汉森博士，明尼阿波利斯适应性设计和工程（MADE）计划的负责人，在 明尼阿波利斯弗吉尼亚州，和博士奥默伊南，博士，电气和计算机工程副教授，在 格鲁吉亚理工大学Ewart博士将与MADE计划合作，执行膝关节的技术构建 矫形器，将麦克风集成其中，并与Inan博士远程合作，分析来自 改进麦克风系统以用于可穿戴设备中的功能。 骨关节炎（OA）是一种常见的致残性疾病。症状的药物和手术治疗 对于许多患者来说，OA的治疗是不够的，并且没有治疗方法可以阻止甚至延迟OA的结构性改变。 疾病的进展。研究此类疗法的一个困难是早期识别患者， 足够的疾病阶段，对关节的损害可能是可逆的。在有OA风险但 在X光片上没有任何迹象，MRI已被证明能够识别膝关节的变化，这些变化可以预测 OA的后续发展。然而，这些发现并不是在所有情况下都是特异性的， 昂贵，耗时，并且不能在护理点使用。声发射的测量 一个现代化的微型麦克风可以区分膝盖的健康状况和疾病， 早期OA筛查的新方法。在目标1中，Ewart博士将与MADE计划和Inan博士的 一个小组原型和迭代设计一个便携式矫形器与集成麦克风系统， 在护理点测量来自膝盖的声发射。在目标2中，Ewart博士将确定患者， 膝关节骨关节炎的发展风险，但无晚期疾病的放射学体征， 将他们膝盖的声发射与健康对照组进行比较。如果声音发射异常- 风险组，将获得其膝关节的MRI，以评估预测放射学发展的结果 和症状进展为OA，验证了声发射诊断早期OA的能力。的 拟议项目的总体目标是开发一种便携式矫形器， 在护理点从膝关节发出的放射物，以识别患有早期放射学检查前OA的患者。伊瓦特医生的 长期目标是开发非侵入性监测关节健康和功能的技术， 为提供者提供有用的临床信息，从而为患者提供特定的治疗，定制矫形器， 并最终改善症状、功能和关节寿命。这项工作将为今后的工作奠定基础。 对病理性声发射的基础及其 应用于骨关节炎。这些研究将在2015年年底的CDA-2奖申请中提出。 SPiRE融资周期。

This is an application for a Small Projects in Rehabilitation Research (SPiRE) award to Dr. David Ewart, MD, a staff rheumatologist at the Minneapolis VA Medical Center and Assistant Professor at the University of Minnesota. Dr. Ewart has a history of research and publications in biomechanics, immunology, and animal models of arthritis and is transitioning to a focus on the treatment and rehabilitation of joint damage. Dr. Ewart is an early career investigator with protected time to establish an independent line of investigation. This SPiRE award will provide Dr. Ewart with the support to: 1) develop a unique interinstitutional collaboration to build an orthosis with an integrated microphone to measure acoustic emissions from the knee at the point of care 2) use acoustic emissions to identify patients with pre-radiographic osteoarthritis of the knee 3) establish a mentored role in a busy research group and generate the preliminary data with which to apply for a career development award (CDA-2). To achieve these goals, Dr. Ewart has established a mentorship team consisting of Dr. Andrew Hansen, head of the Minneapolis Adaptive Design and Engineering (MADE) program at the Minneapolis VA, and Dr. Omer Inan, PhD, Associate Professor of Electrical and Computer Engineering at Georgia Tech. Dr. Ewart will work with the MADE program to perform the technical construction of the knee orthosis, integrate the microphone into it, and collaborate remotely with Dr. Inan to analyze the data from and refine the microphone system for function in the wearable device. Osteoarthritis (OA) is a prevalent and disabling disease. Pharmacologic and surgical treatments for symptoms of OA are insufficient for many patients and there are no therapies which halt or even delay the structural progression of disease. One difficulty in the study of such therapies is identification of patients at an early enough stage of disease that the damage to the joint is potentially reversible. In patients at risk of OA but with no signs of it on x-rays, MRI has been shown to be able to identify changes in the knee that are predictive of subsequent development of OA. However, these findings are not specific in all circumstances and MRI is expensive, time-consuming, and can’t be used at the point of care. Measurement of acoustic emissions from the knee with a modern, miniature microphone can differentiate health in the knee from disease and would offer novel method of screening for early OA. In Aim 1, Dr. Ewart will work with the MADE program and Dr. Inan’s group to prototype and iteratively design a portable orthosis with an integrated microphone system for measuring acoustic emissions from the knee at the point of care. In Aim 2, Dr. Ewart will identify patients at risk for development of osteoarthritis of the knee but without radiographic signs of advanced disease and compare acoustic emissions from their knees to healthy controls. If acoustic emissions are abnormal in the at- risk group, MRIs of their knees will be obtained to assess for findings that predict development of radiographic and symptomatic progression to OA, validating the ability of acoustic emissions to diagnose early OA. The overall objective of the proposed project is to develop a portable orthosis capable of measuring acoustic emissions from the knee at the point of care to identify patients with early pre-radiographic OA. Dr. Ewart’s long-term goal is to develop technology for non-invasive monitoring of joint health and function that can provide useful clinical information to providers that will result in patient-specific therapies, custom orthotics, and ultimately improved symptoms, function, and joint longevity. This work will form the basis for further mechanistic, clinical, and translational investigation into the basis for pathologic acoustic emissions and their application to osteoarthritis. These studies will be proposed in a CDA-2 award application at the end of the SPiRE funding period.