Enhancing AFO Efficacy through Continuous, Non-Invasive Gait Assessment

项目编号：Bennett， b.c, Abel, m.f，和Lach， j.c。提案号：1034071由于脑瘫（CP）而导致行动障碍的个体经常被处方踝关节足矫形器（AFOs）来帮助他们行走和防止肌肉收缩。在估计的76.4万人中，每年有超过50%的人被确诊，另有9500名儿童被确诊。在美国，有一种或多种CP症状的人会被开矫正器，而在世界范围内这个数字要大得多。尽管afo被广泛使用，但目前评估“并最终提高”其在这一人群中的疗效的方法有限。大多数关于使用AFO后步态变化的研究都是基于步态实验室的单次访问数据收集，这些数据只显示了步态力学的短期改善，而没有解决AFO增加活动和参与学校和社会以及预防肌肉挛缩和骨骼畸形的更大目标。获取这些数据将有助于深入了解当前AFO的功效，并为未来的AFO发展提供指导，但在佩戴者的自然环境中更长期、更连续的数据收集是必要的。拟议的项目旨在通过解决非侵入性、连续收集和分析任何地点长时间的步态和活动数据的基本科学和技术挑战，解决仅依赖于临床数据收集的这些局限性。加速度计、陀螺仪、微控制器、非易失性存储器、电池和支持电路将被塑造成afo，传感、预处理和存储运动数据，这些数据随后被下载并进行后处理，以确定活动的数量和类型（例如步行、跑步、爬行）以及各种时空步态参数（例如步幅、脚踝角度等）。这种客观、长期、针对患者的AFO疗效评估将改变医生和步态专家处方和监测AFO使用的方式，并将为未来AFO技术的发展提供信息。临床医生将第一次能够跟踪AFO使用效果的真实世界进展。传感系统是完全非侵入性的，因为它将驻留在afo本身，并且可以研究对不同afo日常性能的影响。影响行为的限制（如爬楼梯）可以记录下来，脚踝位置将作为时间的函数记录下来，以便确定是否保持所需的位置足够长以防止挛缩和畸形。如果使用AFO导致行走能力下降或限制其他活动，临床医生可以修改AFO，规定不同类型的AFO（例如铰链式与实心式），或者可以建议AFO只在部分时间佩戴或根本不佩戴。智力优势：这项工作-汇集了骨科和步态生物力学专家，身体传感器网络专家和骨科医生-将在运动分析和CP辅助技术领域取得若干科学和技术进步。首先，这项工作推进了长期，非侵入性运动数据收集和分析领域。临床医生越来越多地使用循证干预措施，并对临床或实验室以外的日常生活中的定量测量感兴趣。这项工作超越了仅仅测量一般活动或步数（如现有的现成技术所提供的），因为它将提供活动分类和时空步态参数。其次，由此获得的关于儿童带着他/她的afo在世界上如何活动的知识，将为设备的适当性提供反馈，从而在必要时对afo进行更改。最后，这一分析的结果将为未来AFO发展的机会提供见解。更广泛的影响：这项工作的影响从提高对活动的基本理解到改善行走障碍者的生活质量。虽然这项工作的重点是帮助那些患有CP的人，但这项工作的基础科学可以应用于不同残疾个体的afo，以及非侵入性和连续测量其他身体部位/关节运动的能力。此外，这项工作将开发技术，提供将来有源设备投入使用时所需的信息。最后，随着电池和电子设备的改进，在每个AFO中安装传感器将变得可行，这样就可以间歇性地监测步态/活动，以评估性能随时间的变化，而无需实验室访问。

PI: Bennett, B. C., Abel, M. F., and Lach, J. C.Proposal Number: 1034071Individuals with mobility disabilities as a result of cerebral palsy (CP) are often prescribed ankle foot orthoses (AFOs) to aid in their walking and prevent muscle contractures. More than 50% of the estimated 764,000 people with another 9500 children diagnosed each year. in the United States who have one or more symptoms of CP are prescribed orthoses21, with significantly larger numbers worldwide. Despite this widespread use of AFOs, current methods for evaluating " and ultimately enhancing" their efficacy in this population are limited. Most studies of gait changes with AFO use are based on single visit data collections in the gait lab, which only reveal short-term improvements in gait mechanics and do not address the AFOs' larger goals of increasing activity and participation in school and society and preventing muscle contractures and bony deformities. Accessing such data would provide insight into the efficacy of current AFOs and guidance for future AFO development, but longer-term, more continuous data collections in the wearers' natural environments are necessary. The proposed project seeks to address these limitations of solely relying on in-clinic data collections by addressing the fundamental scientific and technical challenges to the non-invasive and continuous collection and analysis of gait and activity data in any location over an extended period of time. Accelerometers, gyroscopes, microcontrollers, non-volatile memory, batteries, and supporting circuitry will be molded into AFOs, sensing, pre-processing, and storing movement data that is later downloaded and post-processed to determine both the amount and type of activity (e.g. walking vs. running vs. crawling) and various spatial-temporal gait parameters (e.g. stride length, ankle angle, etc.). This objective, long-term, patient-specific assessment of AFO efficacy will transform the way doctors and gait specialists prescribe and monitor AFO use and will inform the development of future AFO technologies. For the first time clinicians will be able to follow the real world progress of the effect of AFO use. The sensing system is completely non-invasive as it will reside in the AFOs themselves, and the effect on day-to-day performance of different AFOs can be studied. Limitations that affect behavior (e.g. stair climbing) can be documented, and ankle position will be recorded as a function of time so that it can be determined if desired positions are held long enough to prevent contractures and deformities. If AFO use results in decreased walking performance or limits other activities, the clinician can modify the AFO, prescribe a different type of AFO (e.g. hinged vs. solid), or can suggest that the AFOs only be worn part of the time or not at all.Intellectual Merit: This work - which brings together an orthopedics and gait biomechanics specialist, a body sensor networks expert, and an orthopedic surgeon - will make several scientific and technical advancements in the fields of motion analysis and assistive technologies for CP. First, this work advances the area of long-term, non-invasive movement data collection and analysis. Increasingly, clinicians are using evidence-based interventions and are interested in quantitative measures in daily life, outside of the clinic or laboratory. This work goes beyond the mere measurement of general activity or number of steps (as is provided by existing off-the-shelf technologies) in that it will provide activity classification and spatial-temporal gait parameters. Second, the resulting knowledge of how an individual child is moving in the world with his/her AFOs will provide feedback as to the appropriateness of the devices, enabling changes to the AFOs to be made as necessary. Finally, the results of this analysis will provide insights into opportunities for future AFO development.Broader Impact: The impact of this work spans improved basic understanding of activity to improved quality of life for individuals with walking disabilities. While this work focuses on aiding those with CP, the basic science of this work can be applied to AFOs for individuals with different disabilities as well as the ability to non-invasively and continuously measure the movement of other body segments/joints. In addition, this work will develop technology that will provide information that will be needed in the future when active devices come into practice. Finally, with improved batteries and electronics it will become feasible to build sensors into every AFO so that gait/activities could be monitored intermittently to assess performance changes over time without a lab visit.