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

项目摘要/摘要 脚踝矫形器(AFO)通常用于改善神经系统疾病患者的活动能力。 精神错乱。大多数脑性瘫痪儿童的护理标准中包括了AFO。 (CP)，一种儿童起病的运动障碍，由对发育中的大脑的侮辱引起。当前的治疗目标 对于患有脑瘫的人来说，重点是增加活动水平，重点是玩耍、楼梯导航和跑步 进行适当的社会和社区参与。在这些情况下，踝关节的僵硬程度有很大的不同， 这表明对于最佳AFO刚度也是如此。不幸的是，通常开出的AFO无法 很容易或很快地改变关节的硬度；大多数根本不能改变刚度。结果，充其量也就是一个 AFO刚度仅为在单一条件下以单一速度行走而优化。要解决这个问题 现有AFO设计在适应不同的步行活动方面的局限性，以及脚踝潜在的下降 足底屈肌功能与长期使用AFO治疗慢性前列腺炎患者，这项建议旨在发展一种差异性 和可调刚度AFO(DAS-AFO)。本提案的主要目标是验证以下各项的好处： 客户的需求，差动和可调的刚度特性，并发起客户发现，以设计 性价比高，可制造的最低可行产品。我们的首要目标是确认DAS-AFO的改进 在慢性阻塞性肺病患者步行过程中，跟标准的(医生开的)AFO相比，踝屈肌的推离力量。在一个街区里- 随机顺序，参与者将在跑步机上步行，他们的正常AFO和DAS-AFO调整为 每个参与者只能提供足够的背屈肌僵硬来解决脚下垂问题。我们假设DAS- AFO的设计将显著提高生物推出力量和踝关节的活动范围 正常的AFO，不影响步行经济。我们的第二个具体目标是确认DAS-AFO 与标准的(医生开出的)AFO相比，在CP模式下行走时，可改善趾屈肌群的活动。 我们假设DAS-AFO设计将导致与临床相关的趾屈肌的增加。 与正常的AFO相比，髋关节和膝关节的运动学将在不同的设计之间相似。我们的第三个特别节目 目的是验证在游戏和学校活动中实时调整僵硬的需求和能力；获得 从孩子、他们的父母和矫形师那里得到反馈，以设计MVP。在这个目标中，我们将观察是否和 脑性瘫痪儿童在模拟游戏和学校活动中如何调整AFO僵硬，设计和原型 基于用户和矫形师反馈的最低可行产品，并与AFO制造商接洽。总而言之， 这项工作将产生关于差动和可调刚度AFO如何增强机动性的新知识 而不会阻碍CP患者肌肉健康和运动技能发展所必需的积极参与。

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.