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

这是一份申请康复研究小项目奖(SPIRE)的申请书，授予David Ewart博士，他是 明尼阿波利斯退伍军人医学中心风湿病学家，明尼阿波利斯大学助理教授 明尼苏达州。埃沃特博士在生物力学、免疫学和动物方面有研究和出版的历史 这是一种关节炎模型，并正在过渡到专注于关节损伤的治疗和康复。Dr。 埃沃特是一名早期职业调查员，有受保护的时间来建立独立的调查路线。这 SPIRE奖将为埃沃特博士提供支持，以：1)发展独特的机构间合作，以 建立一个带有集成麦克风的矫形器，以测量膝盖处的声发射 CARE 2)使用声发射来识别放射前膝骨性关节炎患者3)建立 在繁忙的研究小组中担任指导角色，并生成申请职业所需的初步数据 发展奖(CDA-2)。为了实现这些目标，埃沃特博士建立了一个由以下人员组成的导师团队 明尼阿波利斯适应性设计和工程(Made)项目负责人安德鲁·汉森博士 和Omer Inan博士，博士，电气和计算机工程副教授在明尼阿波利斯大学 佐治亚理工学院。埃沃特博士将与Made计划合作，进行膝关节的技术构建 矫形器，将麦克风集成到其中，并与Inan博士远程协作，分析来自和的数据 改进麦克风系统，使其在可穿戴设备中发挥作用。 骨关节炎(OA)是一种常见的致残性疾病。症状的药物和外科治疗 对于许多患者来说，骨关节炎的治疗是不够的，而且还没有治疗方法来停止甚至延迟结构性的 疾病的发展。研究这种疗法的一个困难是在早期识别患者。 足够的疾病阶段，对关节的损害有可能是可逆的。在有骨性关节炎风险但有 在x光片上没有这种迹象，核磁共振成像已经被证明能够识别膝盖的变化，这些变化可以预测 办公自动化的后续发展。然而，这些发现并不是在所有情况下都是特定的，MRI是 价格昂贵，耗时长，而且不能在护理时使用。声发射的测量 带有现代微型麦克风的膝盖可以区分膝盖的健康和疾病，并将提供 早期骨性关节炎筛查的新方法。在目标1中，埃沃特博士将与Made计划和Inan博士的 小组原型和迭代设计便携式矫形器与集成麦克风系统 在护理点测量膝部的声发射。在Aim 2中，Ewart博士将在以下位置识别患者 发生膝骨性关节炎的风险，但没有晚期疾病的放射征象和 将他们膝盖上的声发射与健康对照组进行比较。如果声发射在AT中出现异常- 风险组，将获得他们膝盖的核磁共振成像，以评估预测放射学发展的结果 症状进展为骨性关节炎，验证了声发射诊断早期骨性关节炎的能力。这个 拟议项目的总体目标是开发一种能够测量声学的便携式矫形器 在护理点从膝关节放射来识别早期放射学前骨性关节炎患者。埃沃特医生的 长期目标是开发非侵入性监测关节健康和功能的技术， 向提供者提供有用的临床信息，这些信息将导致针对患者的治疗、定制矫形器、 最终改善了症状、功能和关节寿命。这项工作将为下一步 病理性声发射基础的机制、临床和翻译研究 在骨性关节炎中的应用。这些研究将在年末的CDA-2奖项申请中提出 尖顶资金期。

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.