Robotic Knee Exoskeleton to Reduce Joint Loading and Improve Mobility in Veterans with Medial Compartment Knee Osteoarthritis

机器人膝关节外骨骼可减轻膝关节内侧骨关节炎退伍军人的关节负荷并提高其活动能力

• 批准号: 10016814
• 负责人: Patrick Mark Aubin
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016814
• 关键词: Adult; Affect; Aging; Behavior; Biomechanics; Data; Data Analyses; Degenerative polyarthritis; Development; Disabled Persons; Disease Progression; Dose; Effectiveness; Employment; Gait; Generations; Health; Individual; Intelligence; Kinetics; Knee; Knee Osteoarthritis; Knee joint; Knowledge; Laboratories; Lateral; Machine Learning; Manuals; Measures; Medial; Methods; Minor; Motion; Numeric Rating Scale; Operative Surgical Procedures; Pain; Participant; Pathogenesis; Patient Self-Report; Patients; Performance; Phase; Play; Population; Quality of life; Recreation; Replacement Arthroplasty; Reporting; Research; Research Personnel; Rest; Risk; Risk Factors; Robotics; Role; Scheme; Specific qualifier value; Symptoms; System; Systems Analysis; Testing; Time; United States; User Compliance; Veterans; Walking; Woman; aged; burden of illness; comparative efficacy; design; exoskeleton; experience; functional improvement; head-to-head comparison; improved; improved mobility; instrument; invention; joint function; joint loading; joint mobilization; kinematics; knee pain; mechanical load; men; modifiable risk; osteoarthritis pain; pain reduction; pain relief; preference; pressure; recruit; research study; response; robot exoskeleton; tool; treadmill; treatment strategy

Symptomatic knee osteoarthritis (OA) is a painful condition that reduces mobility, independence, and quality of life for both men and women. About 10% of people aged over 55 years have painful disabling knee OA of whom one quarter are severely disabled. Although a variety of factors influence the pathogenesis of OA, medial compartment knee joint contact loading plays a significant role and importantly, is a modifiable risk factor. Traditional knee unloader braces are a common conservative treatment strategy for those with medial compartment knee OA. Unloader braces are designed to unload the medial compartment of the knee joint thereby slowing disease progression, reducing pain, and improving joint function and mobility. Medial compartment unloading provided by a brace abduction moment (BAM) counteracts the external knee adduction moment (KAM). Unfortunately, traditional knee unloader braces have mixed efficacy and the limited benefits (minimal reduction in pain and minor functional improvements) of wearing the brace do not often outweigh the brace discomfort and hassle of use. One of the shortcomings of traditional knee unloader braces is that the BAM must be manually set by the brace user through strapping and or condyle pad adjustment. This results in infrequent adjustment which often causes an inappropriate BAM setting for a given activity, e.g. strapping has loosened resulting in a BAM that doesn’t provide enough knee unloading during gait, or the subject is at rest but the BAM remains high causing pressure and discomfort at the brace interface. Even when walking BAM modulation within a step could be beneficial. In this scenario, BAM could be reduced during swing phase but then return to a normal level during stance phase. For these reasons, we propose that a new class of smart active braces that dynamically adapt the amount of unloading for a given individual and their activity. This new class of braces has the potential to provide greater medial compartment knee unloading and better pain relief while simultaneously being more comfortable. Therefore, the purpose of this research study is to determine optimal BAM modulation profiles that provide better medial compartment knee unloading, improve brace comfort and reduce knee pain as compared to conventional passive knee unloader braces. To achieve our aims, we have developed an offboard robotic knee exoskeleton (RKE) to serve as a laboratory tool to investigate the potential benefits of active braces with dynamic BAM modulation. For this study, twenty participants will be recruited to walk on an instrumented treadmill while wearing the (RKE). The participants will experience 56 different BAM modulation schemes as parameterized by the BAM turn on time (Ton), turn off time (Toff) and peak Nm BAM level (Pk). Real-time data analysis will allow us to immediately compare the efficacy of each BAM modulation scheme in terms of medial compartment knee unloading (knee adduction angular impulse, KAAI) and brace comfort (brace abduction angular impulse, BAAI). Study participants will then experience a direct comparison of walking with the RKE emulating a traditional passive unloader brace versus walking with the RKE programmed with the identified optimal BAM. Here the participants will self-select their own preferred unloading level (BAM Pk) for each brace type. Self-reported knee pain and brace comfort, as well as KAAI and BAAI of the passive versus active brace will then be compared. These results will allow us to determine if dynamic active braces that deliver intra-step BAM modulation can provide equal or better medial compartment knee unloading (KAAI) while simultaneously being more comfortable and greater pain relief. The development of improved knee unloader braces, that are smart, dynamic, and adaptive have the potential to greatly increase brace efficacy. Improved conservative treatment strategies for medial compartment knee OA could reduce surgical intervention and its associated risks and significantly improve the quality of life for veterans burdened by this disease.

症状性膝关节骨关节炎（OA）是一种疼痛性疾病，可降低活动性、独立性和活动质量。 男人和女人的生活。大约10%的55岁以上的人患有疼痛的致残性膝关节OA， 其中四分之一是严重残疾。虽然多种因素影响OA的发病机制， 内侧间室膝关节接触负荷起着重要作用，重要的是，是一种可改变的风险 因子传统的膝关节卸载支架是一种常见的保守治疗策略， 膝关节间室OA。卸载支架设计用于卸载膝关节内侧间室 从而减缓疾病进展、减轻疼痛并改善关节功能和活动性。内侧 由支具外展力矩（BAM）提供的隔室卸载抵消了外部膝关节 内收力矩（KAM）。不幸的是，传统的膝盖卸载器支架具有混合的功效和有限的功能。 佩戴支具的益处（最小程度地减轻疼痛和轻微的功能改善）并不经常 超过了支具的不适和使用的麻烦。传统膝关节减压器支架的缺点之一 BAM必须由支架使用者通过捆扎和/或髁垫调节手动设置。这 导致不频繁的调整，这通常会导致给定活动的BAM设置不适当，例如 绑带松动，导致BAM在步态期间不能提供足够的膝关节卸载，或者 受试者处于休息状态，但BAM仍然很高，导致支具界面处的压力和不适。甚至 当行走时，一步内的BAM调制可能是有益的。在这种情况下，BAM可以在 摆动阶段，但随后在站立阶段返回到正常水平。基于这些原因，我们建议， 一类智能活动支架，动态适应卸载量为给定的个人和他们的 活动这种新型支具有可能提供更大的内侧间室膝关节卸载， 更好地缓解疼痛，同时更舒适。因此，本研究的目的 研究旨在确定最佳BAM调制曲线，以提供更好的内侧间室膝关节 与传统被动膝关节相比， 卸载支架。为了实现我们的目标，我们开发了一种非车载机器人膝关节外骨骼（RKE）， 作为一个实验室的工具，以调查与动态BAM调制的主动支架的潜在好处。 在这项研究中，将招募20名参与者，让他们在佩戴器械的跑步机上行走， （RKE）.参与者将体验由BAM参数化的56种不同的BAM调制方案 接通时间（Ton）、关断时间（Toff）和峰值Nm BAM水平（Pk）。实时数据分析将使我们能够 立即比较每种BAM调制方案在内侧间室膝关节方面的疗效 无负荷（膝内收角冲量，KAAI）和支具舒适度（支具外展角冲量，BAAI）。 然后，研究参与者将体验步行与模仿传统的RKE的直接比较。 被动卸载器支具与使用已识别的最佳BAM编程的RKE行走。这里 参与者将为每种支具类型自行选择他们自己喜欢的卸载水平（BAM Pk）。自我报告 膝关节疼痛和支具舒适度，以及被动支具与主动支具的KAAI和BAAI， 比较了这些结果将使我们能够确定是否动态积极括号，提供内部步骤BAM 调节可以提供相等或更好的内侧间室膝关节卸载（KAAI），同时 更舒适和更大的疼痛缓解。开发改进的膝关节减压器支架，这是聪明的， 动态的和自适应的具有极大地增加支具功效的潜力。改良保守治疗 膝关节内侧间室OA的治疗策略可以减少手术干预及其相关风险， 显著改善受这种疾病困扰的退伍军人的生活质量。