An adjustable stiffness orthosis to maintain muscle engagement and push-off power in cerebral palsy.

项目总结/摘要 踝足矫形器（AFO）通常用于改善神经系统疾病患者的活动能力。 紊乱AFO包括在大多数脑瘫儿童的护理标准中 (CP)这是一种由发育中的大脑受到损伤而引起的儿科发病的运动障碍。目前的治疗目标 对于患有CP的人，以增加活动水平为中心，重点是玩耍，楼梯导航和跑步 适当的社会和社区参与。踝关节刚度在这些条件下变化很大， 这表明最佳AFO刚度也是如此。不幸的是，通常规定的AFO无法 容易或快速地改变关节刚度;大多数根本不能改变刚度。其结果，充其量，是一个单一的 AFO刚度仅针对在单一条件下以单一速度行走进行优化。解决 现有AFO设计在适应不同步行活动方面的局限性，以及踝关节功能的潜在下降 足底屈肌功能与长期使用AFO的个人与CP，这项建议旨在制定一个差异 和可调刚度AFO（DAS-AFO）。本提案的主要目标是验证以下方面的好处， 客户需要的，差分和可调刚度功能，并启动客户发现设计一个 具有成本效益和可制造的最小可行产品。我们的第一个目标是确认DAS-AFO改善 在CP中行走期间，与标准（医生处方）AFO相比，跖屈肌推出功率。在一个街区- 随机顺序，参与者将在跑步机上行走，他们的正常AFO和DAS-AFO调整为 每个参与者仅提供足够的背屈肌刚度以解决足下垂。我们假设DAS- AFO设计将导致更大的生物推离力和踝关节活动范围， 正常AFO，不影响行走经济性。我们的第二个具体目标是确认DAS-AFO 与标准（医生处方）AFO相比，在CP行走期间改善跖屈肌肌肉活动。 我们假设DAS-AFO设计将导致临床相关的跖屈肌增加 与正常AFO相比的活动;两种设计之间的髋关节和膝关节运动学相似。第三个具体 目的是验证在玩耍和学校活动期间进行实时刚度调整的需求和能力;获得 从孩子，他们的父母和矫形师的反馈来设计MVP。在本目标中，我们将观察 脑瘫儿童在模拟游戏和学校活动中如何调整AFO刚度，设计和原型 根据用户和矫形师的反馈，确定最小可行产品，并与AFO制造商合作。总的来说， 这项工作将使人们对差动和可调刚度的AFO如何增强机动性有新的认识 而不会阻碍CP中肌肉健康和运动技能发展所需的积极参与。

PROJECT SUMMARY/ABSTRACT Ankle foot orthoses (AFOs) are commonly prescribed to improve mobility for individuals with neurological disorders. AFOs are included in the standard of care for the majority of ambulatory children with cerebral palsy (CP), a pediatric-onset movement disorder caused by insult to the developing brain. Current goals of treatment for individuals with CP center around increasing activity levels, with a focus on play, stair navigation, and running for proper social and community participation. Ankle joint stiffness varies considerably across these conditions, which suggests the same for optimal AFO stiffness. Unfortunately, commonly prescribed AFOs are unable to easily or quickly vary the joint stiffness; most are not able to vary stiffness at all. The result, at best, is a single AFO stiffness that is only optimized for ambulating in a single condition at a single speed. To address the limitations in existing AFO designs for adapting to varying ambulatory activities, and the potential decline in ankle plantar flexor function with long-term AFO use in individuals with CP, this proposal seeks to develop a differential and adjustable stiffness AFO (DAS-AFO). The primary goals of this proposal are to validate the benefits of, and customer need for, the differential and adjustable stiffness features, and initiate customer discovery to design a cost-effective and manufacturable minimum viable product. Our first aim to confirm that the DAS-AFO improves plantarflexor push-off power compared to standard (physician prescribed) AFOs during walking in CP. In a block- randomized order, participants will walk on a treadmill with their normal AFOs and with the DAS-AFO tuned for each participant to provide only enough dorsiflexor stiffness to address drop foot. We hypothesize that the DAS- AFO design will result in significancy greater biological push-off power and ankle range of motion compared to normal AFOs without effecting walking economy. Our second specific aim is to confirm that the DAS-AFO improves plantarflexor muscle activity compared to standard (physician prescribed) AFOs during walking in CP. We hypothesize that the DAS-AFO design will result in a clinically-relevant increase in plantarflexor muscle activity compared to normal AFOs; hip and knee kinematics will be similar between designs. Our third specific aim is to validate the need and ability for real-time stiffness adjustment during play and school activities; obtain feedback from the children, their parents, and orthotists to design the MVP. In this Aim, we will observe if and how children with CP adjust their AFO stiffness during simulated play and school activities, design and prototype the minimum viable product based on user and orthotist feedback, and engage AFO manufacturers. Collectively, this work will result in new knowledge on how differential and adjustable stiffness AFOs can augment mobility without blocking the active engagement necessary for muscle health and development of motor skills in CP.