Identifying individual-specific gait signatures for stroke rehabilitation

项目摘要/摘要 卒中步态缺陷是复杂的，其特点是对运动学、动力学、步态对称性和步态间的不良影响。 以及步态周期不同阶段的肢体关节协调。一次干预根本不能针对 中风后步态缺陷的高度个体间变异性。约2/3的中风幸存者 尽管康复出院，但仍有持续性的步态障碍，其中一个原因可能是缺乏 提供量身定制的康复方法，以解决他们个人特有的障碍。量身定做的发展 然而，康复方法受到缺乏识别和分析个体的稳健指标的限制- 步态上的特殊差异。这项工作的目标是开发敏感的、数据驱动的、一致的 使用连续、多关节步态动力学来表征步态。步态的动力学将从 测量的运动学(关节角度)，并用于开发特定于个人的步态特征，我们 发明了“步态标志”。我们将使用这些步态特征来探索中风步态背后的机制 使用康复技术，特别是快速功能电刺激(FastFES)的损害。FastFES 是一种以脚踝背屈肌为目标的步态康复干预，以解决脚下垂和脚踝 拇指屈肌，以提高推举时的脚踝扭矩。文献表明，对FastFes的反应 取决于特定肌肉协调缺陷和步态康复之间的精确匹配 情态。这表明，在康复之前了解个人特定的步态损害可以 预测他们对治疗的反应。由于众所周知，FastFES针对的是与脚踝推脱相关的脚踝缺陷，我将 探索这一理论，并评估步态特征是否可以编码脚踝推离校正以响应 单次接触FastFES。我预测，与脚踝相关的推脱缺陷的中风患者将表现出 他们的步态特征对标准(健全)步态的最大反应或变化。初步调查结果 表明步态特征可以准确地区分不同的中风患者。一个值得注意的发现是 我们的步态信号似乎不会根据行走速度聚集在一起，这导致了我们的假设 根据我们所了解的情况，签名可以区分划臂步态中特定于个体的差异 卒中步态损伤的异质性。我们的目标是确定不同的功能生物力学相关性 步态特征簇，我们将确定FastFes是否针对特定的个体簇 取决于他们的生物力学特征、特征或缺陷。此外，我们还将 确定FastFES暴露前的步态特征是否可以预测中风幸存者是否将成为 FastFES的潜在响应者。如果成功，步态特征将被证明是特定步态的有力标志 并对今后制定有针对性的康复战略有重要影响。 中风幸存者。

PROJECT SUMMARY/ABSTRACT Stroke gait deficits are complex and marked by adverse effects on kinematics, kinetics, gait symmetry, and inter- and intra- limb joint coordination across different phases of the gait cycle. One intervention simply cannot target the high inter-individual variability of deficits observed in post-stroke gait. Approximately 2/3 of stroke survivors have persistent gait impairments despite being discharged from rehabilitation, and one reason could be the lack of tailored rehabilitation approaches to address their individual-specific impairments. The development of tailored rehabilitation approaches, however, is limited by the lack of robust metrics to identify and analyze individual- specific differences in gait. The objective of this work is to develop a sensitive, data-driven, consistent characterization of gait using continuous, multi-joint gait dynamics. The dynamics of gait will be extracted from measured kinematics (joint angles) and used to develop individual-specific gait characterizations, which we coined the ‘gait signature.’ We will use these gait signatures to probe the mechanisms underlying stroke gait impairment using rehabilitation techniques, specifically Fast functional electrical stimulation (FastFES). FastFES is a gait rehabilitation intervention that targets ankle dorsiflexor muscles to address foot drop, and ankle plantarflexor muscles to improve ankle torque at push-off. The literature suggests that response to FastFES depends on the precise alignment between a specific muscle coordination deficit and the gait rehabilitation modality. This suggests that knowledge of an individual’s specific gait impairment before rehabilitation can predict their response to therapy. Since FastFES is known to target ankle deficits related to ankle push-off, I will probe this theory and evaluate whether gait signatures can encode ankle push-off corrections in response to a single session exposure to FastFES. I predict that stroke individuals with ankle-related push-off deficits will show the greatest response or change in their gait signature towards normative (able-bodied) gait. Preliminary findings show that gait signatures accurately discriminate between different stroke individuals. A noteworthy finding is that our gait signatures do not appear to cluster according to walking speed, leading to our hypothesis that gait signatures distinguish individual-specific differences in stroke gait corresponding to what we know about heterogeneity in stroke gait impairments. We aim to determine the functional biomechanical relevance of various clusters of gait signatures, and we will determine whether FastFES targets a specific cluster of individuals depending on the biomechanical features, characteristics, or deficits that they have. Furthermore, we will determine whether gait signatures before FastFES exposure can predict whether stroke-survivor will be a potential responder to FastFES. If successful, gait signatures will prove to be a robust marker of specific gait impairments and have important implications for the development of future tailored rehabilitation strategies for stroke survivors.