CAREER: Improving Postural Balance and Rehabilitation Outcomes Using Vibrotactile Sensory Substitution

0846471 Sienko该奖项是根据2009年美国复苏和再投资法案（公法111-5）资助的。研究和教育目标：平衡障碍影响了大量的个体，包括老年人和前庭缺陷，周围神经病变，创伤性脑损伤和中风。认识到这种生活质量下降，本研究的目标是：1）设计和构建感觉替代技术平台，以增强当前的平衡康复最佳实践，2）评估感觉替代在运动活动期间改善稳定性的能力，3）评估与关注由感觉替代设备提供的信息相关的认知工作负荷，4）确定振动触觉反馈对跌倒预防的影响，以及5）检查患者在使用感觉替代技术进行训练后是否能够保持平衡的改善。平衡受损人群，包括前庭、外伤性脑损伤、中风和老年人的前庭，将与密歇根大学、芝加哥康复研究所、西北大学和沃尔特里德陆军医疗中心的同事合作进行测试。本研究旨在探讨控制站立和运动对振动触觉感觉替代的反应的机制，同时强调在整个设计过程中与预期患者人群和康复管理人员（大多数情况下是物理治疗师）的共同创造。将通过一项综合教育计划进一步研究和实施这一共同创造过程，该计划将在更广泛的全球健康背景下审查医疗器械共同创造。为此，PI将在密歇根大学工程学院开设全球健康设计辅修课程;这个未成年人将包括沉浸式体验，学生前往发展中国家，通过与最终用户合作并直接评估其需求来学习共同创造的过程，然后是两个课程的顶点设计序列，其中这些经验被转化为医疗器械设计，可以更现实地实现更广泛的影响。虽然PI和其他人的先前工作表明，振动触觉反馈可以显着改善站立期间的平衡，但其在步态期间改善平衡的应用仍然在很大程度上未被探索，其作为平衡受损个体的康复工具的功效也是如此。一个主要的障碍站在其使用这些关键的应用程序的方式是目前缺乏知识的生物力学参数最适合在运动过程中的振动触觉反馈。这项研究将集中在发现反馈变量和振动触觉显示策略，可以提高步态和平衡康复结果的稳定性。例如，该设备将具有显示步态速度、步幅和注视的振动触觉反馈的独特能力，治疗师定性地使用这三个重要变量来纠正前庭病步态。从这些研究中获得的知识将不仅对振动触觉反馈有用，而且对旨在克服平衡缺陷的广泛的感觉替代装置也有用。最终，本研究的目标是为人体工程学，经济实惠，可穿戴的感觉替代原型，使平衡受损的人能够进行日常生活活动，提高他们的生活质量。在康复环境中，该设备有可能通过提供关于身体运动的连续信息来影响平衡功能的恢复速率和恢复程度，这些信息证实了治疗师提供的口头和触觉反馈。该教育计划强调共同创造医疗技术以促进全球健康，其更广泛的影响包括为美国和发展中国家开发负担得起的医疗设备，教育本科生和研究生在工程设计过程中纳入最终用户输入的必要性，以及向广大受众传播全球健康问题。

0846471SienkoThis award is funded under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5)."Research and Education Objectives: Balance impairments affect a large population of individuals including the elderly and those with vestibular deficit, peripheral neuropathy, traumatic brain injury, and stroke. Recognizing this reduced quality of life, the goals of this research are: 1) To design and build a sensory substitution technology platform to augment current balance rehabilitation best practices, 2) To assess the capability of sensory substitution to improve stability during locomotor activities, 3) To evaluate the cognitive workload associated with attending to information provided by a sensory substitution device, 4) To determine the effect of vibrotactile feedback on fall prevention, and 5) To examine whether or not a patient can retain improvements in balance following training with sensory substitution technology. Balance-impaired populations including vestibular, vestibular secondary to traumatic brain injury, stroke, and the elderly will be tested in collaboration with colleagues at the University of Michigan, Rehabilitation Institute of Chicago, Northwestern University, and Walter Reed Army Medical Center. This research proposes to investigate the mechanisms that govern standing and locomotor responses to vibrotactile sensory substitution while emphasizing co-creation with both the prospective patient population and those administering rehabilitation (physical therapists in most cases) throughout the design process. The study and implementation of this co-creation process will be pursued further through an integrated educational program that examines medical device co-creation in a broader context of global health. To this end, the PI will implement a Global Health Design Minor in the University of Michigan's College of Engineering; this minor will include an Immersion Experience in which students travel to the developing world to learn the process of co-creation by working with and directly assessing the needs of end users, followed by a two-course capstone design sequence in which these experiences are translated into medical device designs than can more realistically achieve broader impact.Intellectual Merit: While prior work by the PI and others has suggested that vibrotactile feedback can significantly improve balance during stance, its application in improving balance during gait remains for the most part unexplored, as does its efficacy as a rehabilitation tool for balance-impaired individuals. A major obstacle standing in the way of its use for these critical applications is the current lack of knowledge regarding the biomechanical parameters best suited for vibrotactile feedback during locomotion. This research will focus on uncovering feedback variables and vibrotactile display strategies that can improve both stability during gait and balance rehabilitation outcomes. For example, the device will have the unique capability to display vibrotactile feedback of gait velocity, stride length, and gaze-three important variables that therapists qualitatively use to correct vestibulopathic gait. The knowledge gained from these studies will be useful not only for vibrotactile feedback but also for the broad range of sensory substitution devices aimed at overcoming balance deficits.Broader Impacts: Ultimately, it is the goal of this research to provide scientific justification and device development for an ergonomic, affordable, wearable sensory substitution prototype that would enable balance-impaired individuals to perform activities of daily living and improve their quality of life. In a rehabilitation setting, the device has the potential to impact both the rate of recovery of balance function and the extent to which recovery is achieved by providing continuous information about body motion that corroborates verbal and tactile feedback provided by therapists. The broader impacts of the educational plan emphasizing co-creation of medical technologies for global health include the development of affordable medical devices for the U.S. and developing world, the education of undergraduate and graduate students in the necessity of incorporating end-user input during engineering design, and the dissemination of global health issues to a broad audience.