A Biofeedback Smart Cane to Reduce Knee Loading Associated with Osteoarthritis

 描述(由申请人提供)： 项目摘要/摘要膝骨性关节炎(OA)是成人致残的五大原因之一。约25%的膝骨性关节炎患者行走时有疼痛，日常生活中的主要活动(ADL)如行走1/4英里、爬楼梯或跪地都有困难。发生在胫股内侧膝关节的机械负荷与膝骨性关节炎的发生和发展密切相关。膝关节内收力矩是衡量膝关节负荷的一个指标，它与内侧骨性关节炎的存在、放射学疾病的严重程度、进展速度和膝关节骨性关节炎症状的存在有关。OA患者的一种保守治疗方法是使用拐杖。研究表明，如果获得适当的拐杖负荷，在患膝对侧使用拐杖可以显著减少关节所承受的中间负荷。适当的甘蔗负荷意味着甘蔗支撑一个人体重的很大一部分，例如15%的体重。最近的研究表明，施加在拐杖上的负荷越大，导致的膝关节内侧负荷减少的幅度就越大。减少膝关节内侧负荷的重要性是显著的。例如，在六年的时间里，峰值KAM增加20%，会导致膝骨性关节炎风险增加6倍。虽然如果正确使用手杖是有效的，但有证据表明，很少有患者接受如何使用手杖的指导。67%的老年社区甘蔗使用者自行开出甘蔗处方，82%的人没有接受过医疗专业人员的教育或示范。因此，我们建议开发一种使用直观、鼓励更大的拐杖负荷并被证明比传统拐杖更有效地减少膝关节负荷的手杖的开发将对膝骨性关节炎患者群体有利。我们的目标是开发和验证一种智能手杖，它可以通过引导用户保持更大的纵向力来促进甘蔗的正确加载。智能甘蔗使用实时振动触觉生物反馈来通知用户何时已经实现了适当的甘蔗负载。智能甘蔗的第一个原型已经开发出来，当特定的甘蔗负载(以体重百分比表示)施加到甘蔗上时，它通过手柄振动向用户发出信号。在这项研究中，我们建议评估智能手杖与传统手杖相比在增加甘蔗负荷和减少膝部负荷方面的能力。具体地说，我们的目标是证明：1)与传统拐杖相比，使用智能拐杖行走时的甘蔗负载量更大；2)与传统拐杖行走相比，使用智能拐杖行走时甘蔗的KAM减少。我们假设H1)使用智能甘蔗时的平均峰值甘蔗负载大于使用常规甘蔗时的平均峰值甘蔗负载，H2)使用智能甘蔗时的平均峰值Kam小于使用常规甘蔗时的平均峰值Kam，并且当比较常规甘蔗实践前后一周时的平均峰值甘蔗负载时，平均峰值甘蔗负载将更大(H3.1)，Kam将降低(H3.2)。我们相信，简单的生物反馈技术可以用来提高手杖的功效。实时地将拐杖力传递给使用者，可以使膝骨性关节炎患者更准确和一致地将拐杖加载到适当的水平。这种持续的长期正确使用拐杖有可能导致膝部负荷的持续减少，从而减轻膝部疼痛并改善膝关节功能。开发更有效的保守治疗策略，可以减缓关节恶化的进展，将使膝骨性关节炎患者受益，并提高他们的生活质量。

 DESCRIPTION (provided by applicant): Project Summary/Abstract Knee osteoarthritis (OA) is one of five leading causes of disability among adults. About 25% of people with knee OA have pain on walking and have difficulty doing major activities of daily living (ADLs) such as walking 1/4 mile, climbing stairs, or kneelin. Mechanical loading that occurs at the medial tibiofemoral knee joint is strongly associated with the development and progression of knee OA. The knee adduction moment is one measure of knee loading that is associated with medial compartment OA presence, radiographic disease severity, rate of progression, and the presence of OA symptoms. One conservative treatment method for OA patients is the prescription of a walking cane. Studies have shown cane use contralateral to the affected knee can significantly reduce the medial load experienced by the joint if proper cane loading is achieved. Proper cane loading implies the cane supports a substantial portion of one's body weight, e.g. 15% body weight. Recent work has shown that the greater the load placed on the cane the greater the resulting reduction in medial knee load. The importance of reducing the medial knee load is significant. For example, a 20% increase in peak KAM was shown to lead to a 6-fold increase in the risk of knee osteoarthritis over a six-year period. While walking canes can be effective if used correctly there is evidence that very few patients receive instruction on how to use a cane. Sixty seven percent of senior living community cane users self- prescribe their canes and 82% receive no education or demonstration from medical professionals. Therefore we propose that the development of a walking cane that is intuitive to use, encourages greater cane loading, and shown to be more effective at reduce knee loading than a conventional cane would be beneficial for the knee OA patient population. We aim to develop and validate a smart cane that can facilitate proper cane loading by guiding the user to maintain greater longitudinal forces through the cane. The smart cane uses real-time vibrotactile biofeedback to inform the user when proper cane load has been achieved. A first prototype of the smart cane has already been developed which signals the user via handle vibration when a specific cane load, expressed in terms of percent body weight has been applied to the cane. For this study, we propose to evaluate the smart cane in terms of the its ability to increase cane loading and decrease knee loading as compared to a conventional walking cane. Specifically, we aim to demonstrate that, 1) cane loading is greater when walking with a smart cane as compared to walking with a conventional cane and 2) the KAM is reduced when walking with a smart cane as compared to walking with a conventional cane. We hypothesis that H1) mean peak cane load when using a smart cane is greater than mean peak cane load when using a conventional cane, H2) mean peak KAM when using a smart cane is less than mean peak KAM when using a conventional cane, and that mean peak cane loading will be greater (H3.1) and KAM will be reduced (H3.2) when comparing regular cane use before and one week after smart cane practice. We believe that simple biofeedback technologies can be used to improve the efficacy of walking canes. Relaying cane force to the user in real-time may allow knee OA patients to more accurately and consistently load their walking cane to the appropriate level. This consistent long term proper cane use has the potential to result in persistent reduction of knee loading resulting in a decrease in knee pain and improved knee joint function. Developing more effective conservative treatment strategies that can slow the progression of joint deterioration would benefit those suffering from knee OA and improve their quality of life.