A computational design of lower limb amputee rehabilitation using functional electrical stimulation

全球每年有100多万人因血管疾病、创伤和癌症而截肢。由于糖尿病发病率的增加和人口老龄化，截肢人数预计会增加，预计到2050年截肢人数将翻一番。假体可以在截肢后一定程度上恢复功能活动。然而，无论是被动的还是主动的假体都不能直接解决全球数百万截肢者的慢性疼痛和肌肉萎缩的根本问题。慢性截肢相关疼痛损害功能。此外，患肢早期功能下降会导致进行性肌肉萎缩和力量丧失。同时，发生机械适应，以补偿由于失去肢体而产生的集体效应。一种常见的补偿策略是在时间和强度方面使完好的肢体超负荷，这会导致继发性肌肉骨骼疾病，进一步损害他们与健康相关的生活质量。该项目将通过开发一种新的功能性电刺激(FES)设备来满足截肢者明显的未得到满足的需求。一种突破性的、基于预测性肌肉骨骼建模的计算方法将被开发并集成到该设备中，以设计以患者为中心的康复。该装置有可能在疼痛管理和提高活动能力方面开出最佳的康复方案；它的长期应用将防止肌肉骨骼疾病的发生和进展，并最终提高生活质量。丁博士将得到一个由研究人员、商业专家、临床医生和患者组成的多学科团队的支持，以确保该项目将影响到各个利益相关者。患者：考虑到截肢后多种并发症的高风险，这种新一代疗法的开发将吸引全球数百万截肢者。更重要的是截肢者康复服务的费用。对于一个平民截肢者来说，头5年的康复费用大约是107,200美元。对于军事截肢者来说，费用将更高，因为他们在受伤时年龄较小，而且社会成本将在较长时间内发生。因此，证明新型装置在截肢者康复中的有效性将具有显著的社会经济影响。临床医生：计算机化的康复设计具有提高康复路径中临床决策的潜力。通过对个别患者的表现进行建模并预测在硅环境中的结果，该建模方法将提高患者对当前实践的满意度。该项目将为工程师和临床医生创造一个协作环境，分享智力投资，并在临床上对计算建模和模拟产生广泛影响。医疗器械行业：FES疗法在截肢者人群中的应用将直接扩大电刺激器的市场规模。FES制造商可以在其现有产品中实例化康复方案，以满足应用程序或为截肢者开发单独的产品。将预测截肢者肌肉骨骼模型纳入产品设计将缩短上市时间并改善患者预后。长期的FES应用还将使电极、传感器和电池等FES组件的制造商受益，并增加更广泛的社会经济影响。教育受益者：该项目将允许丁博士作为STEM(科学、技术、工程和数学)大使在当地学校开展活动，重点关注STEM科目的生物力学应用。此外，她还将在她的实验室网站上传播令人印象深刻的肌肉骨骼建模和模拟的动画和案例研究，以吸引更多的学生学习生物力学，产生更广泛的学术影响。

There are more than one million annual amputations globally as a result of vascular diseases, trauma and cancer. Due to the increasing rate of diabetes and the population ageing, a growth of amputation is expected with the prediction that the amputee population will double by 2050. A prosthesis allows a certain restoration of functional mobility after an amputation. However, neither passive nor active prostheses can directly address the fundamental problems of chronic pain and muscle atrophy in millions of amputees worldwide. Chronic amputation-related pain impairs function. In addition, the early decline in the use of the affected limb results in progressive muscle atrophy with strength loss. Concurrently, a mechanical adaption occurs in order to compensate for the collective effects due to limb loss. A common compensation strategy is to overload the intact limbs in terms of time and intensity, which will cause secondary musculoskeletal disorders, further compromising their health-related quality of life. The project will target the clear unmet needs of amputees by developing a novel functional electrical stimulation (FES) device. A ground-breaking, computational approach based on predictive musculoskeletal modelling will be developed and integrated into the device to design patient-centred rehabilitation. This device has the potential to prescribe the optimal rehabilitation protocol in pain management and mobility enhancement; its long-term application will prevent the onset and progress of musculoskeletal disorders and ultimately improve the quality of life. Dr Ding will receive support from a multidisciplinary team of researchers, business experts, clinicians and patients to ensure the project will impact various stakeholders. Patients: given the high risk of multiple complications after an amputation, the development of such a new generation of therapies will be attractive to millions of amputees worldwide. Of further importance, are the costs of amputee rehabilitation services. To a civilian amputee, the rehabilitation cost in the first 5 years is approximately $107,200. To the military amputees, the costs will be even higher as they are younger at the time of injury and societal costs will be incurred over a longer period. As such, to prove the efficacy of the novel device in amputee rehabilitation will have a significant socioeconomic impact.Clinicians: the computational rehabilitation design has the potential to enhance clinical decision making in the rehabilitation pathway. By modelling individual patient's performance and predicting the outcomes in the in-silico environment, the modelling approach will improve patient's satisfaction to current practice. The project will create a collaborative environment for engineers and clinicians to share intellectual investment and make a broad impact of computational modelling and simulation in the clinic. Medical device industry: the application of FES therapy to the amputee population will directly expand the market size of electrical stimulators. The FES manufacturers could instantiate the rehabilitation protocol in their existing products to fulfil the application or develop a standalone product for amputees. The incorporation of the predictive amputee musculoskeletal model in the product design will lead to a reduced time to market and improved patient outcomes. The long-term FES application will also benefit the manufacturers of FES components such as electrodes, sensors and battery and add a broader socioeconomic impact.Educational beneficiaries: the project will allow Dr Ding as a STEM (Science, Technology, Engineering and Maths) Ambassador to run activities in local schools focus on the biomechanics applications of STEM subjects. Also, she will disseminate impressive animations and case studies on musculoskeletal modelling and simulation in her lab website to attract a broad range of students to study biomechanics, making a wider academic impact.