ZeroG: Dynamic over-ground body-weight support system

描述（由申请人提供）：即使是最熟练的治疗师，成功地为有严重行走缺陷的个体提供强化且安全的步态治疗也是最大的挑战。在许多神经损伤的急性阶段，如中风、脊髓损伤或创伤性脑损伤，患者通常表现出高度不稳定的行走模式和较差的耐力，这使得患者和治疗师都很难安全地练习步态。正因为如此，康复中心大力推动将地面步态训练转移到跑步机上，在跑步机上，体重支持系统可以帮助减少跌倒，同时提高训练强度。许多研究已经调查了体重支持跑步机训练的有效性，并发现这种步态训练模式可以促进步行能力的提高，与传统的步态训练相似或更好。不幸的是，市场上的技术还没有将训练对象从跑步机上的训练过渡到安全的、有重量支撑的地面步态训练。练习在地面上行走是至关重要的，因为我们最近的研究已经证明了在跑步机上行走和在地面上行走之间的关键区别。此外，跑步机行走不允许个人练习日常生活活动（adl），如坐立、爬楼梯、不平坦的地形或从地板上站起来。由于所有行走障碍患者的主要目标是在家中和社区中行走，因此治疗干预包括基于adl的地面步态训练是必要的。自2005年夏天以来，我们一直在开发一种名为ZeroG的地面体重支持步态训练系统，该系统为有步态障碍的个人在练习地面行走以及平衡和姿势活动时提供他们体重百分比的动态卸载。该系统沿着高架轨道运行，提供静态和动态卸载，并有一个主动小车，这样系统就会自动跟随受试者行走。在这里，一个小电机驱动系统，使它保持在被摄者的正上方，当他们在地面上行走，或者可以定位在被摄者的前面或后面，以抵抗或促进运动。有了ZeroG，步态障碍最严重的人可以在受伤后早期安全地练习行走、平衡和姿势任务。在第一阶段的SBIR中，我们通过使用更大的电机重新配置系统，增强了ZeroG的小车跟踪能力，开发并测试了更准确、更健壮的跟踪算法，并对新系统进行了测试，验证了我们期望的性能标准。新系统允许受试者以更快的速度行走，并且额外的力量能力有助于控制受试者在跌倒时的前进动量，并在将受试者从轮椅上抬起或离开地板时保持稳定。此外，该系统性能的改进现在将允许我们开发更先进的模拟adl的训练活动，这可能会提高治疗效果。这个阶段II SBIR的目标是在性能和可用性方面扩展ZeroG的功能。具体来说，我们将开发先进的基于adl的训练模式，如坐到站、坐到站到步、站到坐和一个自适应控制器，根据受试者的行走表现自动调节体重支持。我们还将为ZeroG开发一个无线接口，使治疗师无需在用户界面前就可以控制系统的各个方面。最后，我们将开发培训模块，详细介绍治疗师可以与患者一起练习的各种培训活动，从简单的活动（例如坐平衡，躯干控制）到高水平的活动（例如平衡平台，左右交叉行走等）。将高级训练活动添加到ZeroG中，将使下肢受损的个人能够安全地练习地面步态，以及姿势和动态平衡任务，使其成为世界上最通用的步态训练系统之一。此外，增加无线接口以及详细的培训模块将确保治疗师充分利用系统的功能。我们相信，与现有的传统康复策略相比，使用ZeroG进行训练的个体将在地面行走能力和平衡控制方面获得更大的收益，因为ZeroG将允许治疗师在神经损伤后早期以安全、可控的方式对患者进行广泛的活动训练。ZeroG可用于各种致残状况的功能康复，包括中风和脊髓损伤到截肢，以及有跌倒风险或骨科损伤的老年人。除了临床益处，这种性质的体重支持系统也可以用于促进新的研究，重点是步态障碍和平衡问题。

DESCRIPTION (provided by applicant): Successfully delivering intensive yet safe gait therapy to individuals with significant walking deficits presents the greatest challenges to even the most skilled therapists. In the acute stages of many neurological injuries such as stroke, spinal cord injury, or traumatic brain injury, individuals often exhibit highly unstable walking patterns and poor endurance, making it difficult to safely practice gait for both the patient and therapist. Because of this, there has been a big push in rehabilitation centers to move over-ground gait training to the treadmill where body-weight support systems can help minimize falls while at the same time raising the intensity of the training. Numerous studies have investigated the effectiveness of body-weight supported treadmill training and have found that this mode of gait training promotes gains in walking ability similar to or greater than conventional gait training. Unfortunately there is a gap in technologies on the market for transitioning subjects from training on a treadmill to safe, weight-supported over-ground gait training. Practicing walking over-ground is critical, as our recent studies have demonstrated key differences between walking on a treadmill and walking over-ground. Additionally, treadmill walking does not allow individuals to practice Activities of Daily Living (ADLs), such as sit-to-stand, stairs, uneven terrain, or getting up off the floor. Since a primary goal of all individuals with walking impairments is to walk in their homes and in the community, it is imperative that therapeutic interventions involve ADL-based over-ground gait training. Since the summer of 2005, we have been developing an over-ground body-weight support gait training system called ZeroG, which provides individuals with gait impairments dynamic unloading of a percentage of their body-weight as they practice walking over-ground as well as balance and postural activities. The system, which rides along an overhead rail, provides both static and dynamic unloading, and has an active trolley such that the system automatically follows the subject as they walk. Here, a small motor drives the system so that it stays directly above the subject as they walk over-ground, or can be positioned in front of or behind the subject to resist or facilitate motion. With ZeroG, individuals with the most significant gait impairments can safely practice walking, balance and postural tasks early after their injuries. During our Phase I SBIR, we enhanced the trolley tracking capabilities of ZeroG by reconfiguring the system with a larger motor, developed and tested a more accurate and robust tracking algorithm, and conducted tests with the new system verifying our desired performance criteria were all met. The new system allows subjects to walk at faster speeds, and the additional force capabilities help to control the forward momentum of the subject during falls and for stabilization when lifting the subject from their wheelchair or off the floor. In addition, the improved performance of the system will now allow us to develop more advanced training activities that simulate ADLs, which may lead to enhanced therapeutic benefits. The goals of this Phase II SBIR are to extend the capabilities of ZeroG in terms of both performance as well as usability. Specifically, we will develop advanced ADL-based training modes such as sit-to-stand, sit-to-stand- to-step, stand-to-sit and an adaptive controller that automatically regulates body-weight support based on the subject's walking performance. We will also develop a wireless interface for ZeroG, allowing therapists to control all aspects of the system without having to be in front of the user-interface. Finally, we will develop training modules that detail various training activities therapists can practice with their patients, ranging from easy activities (e.g. sitting balance, trunk control) to high-level activities (e.g. balance platforms, side-to-side cross-over walking, etc). Adding advanced training activities to ZeroG will allow individuals with lower limb impairments the ability to safely practice over-ground gait, as well as postural and dynamic balance tasks, making it one of the most versatile gait training systems in the world. Additionally, adding a wireless interface as well as detailed training modules will ensure that therapists fully utilize the capabilities of the system. We believe that individuals who train with ZeroG will experience enhanced gains in over-ground walking ability and balance control when compared to existing conventional rehabilitation strategies as ZeroG will allow therapists to train patients through a broad spectrum of activities early after neurological injuries in a safe, controlled manner. ZeroG can be used in the functional rehabilitation of various disabling conditions, including stroke and spinal cord injury to amputations and with elderly individuals at risk for falls or following orthopedic injuries. In addition to clinical benefits, a body-weight support system of this nature can also be used to foster new research studies that focus on gait impairments and balance issues.