Characterizing Activity Patterns in Functional Mobility After Spinal Cord Injury

摘要 我的职业生涯和研究兴趣一直集中在运动科学和最大限度地 机动性。无论是通过伤病预防、辅助技术还是生物力学优化，它都是 对临床实践至关重要的是要充分了解这些过程，以便我们能够提供最有见地的 病人治疗。为了进行更有效的以临床为基础的研究，为患者护理提供信息，我的 我希望通过正式课程的实际经验和一名 在以下领域有强大的指导团队：(1)基于活动的数据收集和分析；(2)使用 先进的统计方法，调查多个因素。通过K23，我也将获得经验 特别关注我向独立的过渡；这将包括勇气和实验室管理， 领导临床和转化性研究的设计和实施，管理人员和 会议，追求终身教职和R01。这一持续培训将在以下背景下完成 描述脊髓损伤(SCI)后功能活动模式的研究。 这项研究的目标1是根据患者的情况预测出院时和出院后一年的活动能力 知识产权审查期间的特点和活动。移动性结果可能很难预测，特别是对于 有中等力量和感官障碍的个人。选择合适的培训越来越多 重要的是缩短的停留时间，并存在潜在的机会成本和不利后果 关于没有接受适当干预的个人的生活质量和参与。其他内容 我们可以通过利用低成本传感器在知识产权展期早期收集的活动措施有可能 提供丰富的数据集，我们可以检查这些数据集，以便在几乎没有管理负担的情况下深入了解结果。 使用机器学习方法，我们将调查患者特征和活动监测数据，以 根据康复住院早期获得的数据，改进患者活动能力的预测模型。实现这些目标 AIMS将提高患者和临床医生对下一年活动能力预期变化的理解 SCI以适当的预期和干预为目标，以最大限度地提高功能结果。 这项建议的目标2是定量评估功能活动的变化(即轮式行走 或模式内活动的变化)，以及它们对生活质量的影响 参与。出院后有一些因素会挑战或增强步行的可持续性 功能流动性包括能源成本、神经恢复和生物心理社会因素，如恢复力， 自我效能感、环境和照顾者支持。这些因素与出院后的关系 流动性的变化还没有得到很好的理解。使用可穿戴传感器，我们将量化行走和 轮动以识别行走和旋转之间的转换，确定影响这些转换的因素 并调查其对参与度的影响。

Abstract My career and research interests have centered on the science of movement and factors that maximize mobility. Whether this is through injury prevention, assistive technology, or biomechanical optimization, it is critical to clinical practice that these processes be well understood so that we can provide the most informed patient treatments. In order to carry out more effective clinically-based studies that inform patient care, it is my desire to continue my training through practical experiences with both formal coursework and a oversight by a strong mentoring team in the following domains: (1) activity-based data collection and analysis and (2) use of advanced statistical methods to investigate multiple factors. Through the K23, I will also gain experience specifically focused on my transition to independence; this will include grantsmanship and lab management, leading the design and implementation of clinical and translational studies, management of personnel and meetings, and pursuit of tenure and an R01. This continued training will be completed in the context of a research study that characterizes activity patterns in functional mobility after spinal cord injury (SCI). Aim 1 of this study is to predict mobility at discharge and at 1-year post-discharge, based upon patient characteristics and activity during IPR. Mobility outcomes can be challenging to predict, particularly for individuals with moderate strength and sensory impairments. Selecting appropriate training is increasingly important with shrinking lengths of stay and there are potential opportunity costs and adverse consequences on quality of life and participation for individuals who do not receive appropriate interventions. Additional activity measures that we can collect early in the IPR stay, by utilizing low-cost sensors, have the potential to provide rich data sets that we can examine to garner insight into outcomes with little administrative burden. Using a machine learning approach, we will investigate patient characteristics and activity-monitoring data to improve predictive models of patient mobility based on data acquired early in the rehab stay. Achieving these aims will improve patient and clinician understanding of anticipated changes in mobility in the year following SCI to appropriately target expectations and interventions to maximize functional outcomes. Aim 2 of this proposal is to quantitatively evaluate functional mobility changes (i.e., wheeling walking or changes in activity within mode) in the first year post injury and their impact on quality of life and participation. There are factors following discharge that challenge or enhance the sustainability of walking for functional mobility including energy costs, neurologic recovery and biopsychosocial factors such as resilience, self-efficacy, environment, and caregiver support. The association between these factors and post-discharge changes in mobility are not well understood. Using wearable sensors we will quantify time spent walking and wheeling to identify transitions between walking and wheeling, identify factors that contribute to these transitions and investigate their impact on participation.