基于WRI曲线图的截瘫FES行走稳定性评估新方法

本研究介绍了利用步行器倾翻指数(WRI)曲线图来评估截瘫功能性电刺激(FES)行走稳定性的新方法。其主要构件是一套基于标准步行器的测试系统，该系统可以实时获得三维上肢支撑力数据，进而转化成行走过程中的纵向和侧向WRI曲线图来显示量化的行走稳定性水平。有关实验校准和临床测试结果均表明新方法在稳定性评估方面有很好的临床应用前景，并有望在截瘫FES设计及康复训练中发挥作用。     

肌电控制截瘫病人步行系统的研制

本文介绍肌电控制截瘫病人步行系统应用计算机技术和信号处理技术。该技术能使病人在自我意识的控制下,利用瘫痪下肢在功能性电刺激作用下产生肌力,完成坐下、起立、迈步行走等基本功能运动。     

往复式步行支架在截瘫患者中的运用

脊髓损伤的患者,由于病程长、恢复慢、并发症多等诸多因素,在治疗的过程中使用往复式步行支架,能够帮助患者们行康复训练起到了一定的辅助作用,提高患者生活自理能力。     

基于步行器行走的上肢动力学研究

目前步行器已被广泛用于提高患者的行走能力和稳定性,但针对步行器有效使用的上肢动力学研究却开展得十分有限.本文提出了一种通过测量步行器行走过程中的力学和运动学数据,运用逆动力学反演来分析以关节荷重力矩表征的上肢动力学状况的新方法.其主要构件是一套新开发出的基于步行器的动态测力系统和Vicon运动分析系统,测试数据的采集对象包括七个健康青年人,使用模式为下肢半荷重(50%体重).测试结果验证了该方法的可行性和在步态研究方面的潜在应用前景.     

胸段脊髓损伤患者应用截瘫步行矫形器对下肢康复的影响

背景：胸段脊髓损伤常导致双下肢截瘫,截瘫步行矫形器能帮助截瘫患者改善下肢功能障碍,提高日常生活活动能力,重获站立和行走能力。 目的：探讨截瘫步行矫形器对胸段脊髓损伤患者下肢肌肉痉挛及功能恢复的影响。 方法：将20例胸段脊髓(T5-12)损伤患者根据损伤平面按美国脊髓损伤协会(American Spinal Injury Association,ASIA)标准分为完全损伤组和不完全损伤组,各10例,均装配截瘫步行矫形器。分别于装配前进行残余肌力训练、坐位平衡训练、转移训练;装配后平行杆内站立训练、平衡及转移训练;室内、户外助行器、肘拐步行训练。 结果与结论：与治疗前相比,胸髓完全性损伤患者装配截瘫步行器治疗12周后ASIA评分增加,感觉无明显变化,痉挛随病程的延长而加重;不完全性损伤患者治疗12周后ASIA评分增加,感觉明显改善,痉挛随病程的延长无改变;两组患者日常生活活动能力(改良Barthel指数、功能独立性评测)有显著改善。与治疗2周时相比,治疗12周时2组患者10 m行走时间显著减少,6 min步行距离延长。说明胸段脊髓损伤患者装配截瘫步行器,能显著改善患者的运动功能、日常生活活动能力和步行能力,对肌痉挛控制也有一定的影响。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

遗传性痉挛性截瘫家系的临床遗传学研究

遗传性痉挛性截瘫是一种以缓慢进行的痉挛性下肢瘫为主要临床表现并伴有锥体束征及不同变异征候的疾病［１］。我们在临床遗传咨询工作中对三个同类家系进行了分析、研究,报告如下。病列与家系１．对象本院遗传咨询门诊病人,共３个家系１７例。２．方法（１）临床诊断,...     

重心移动式截瘫步行矫形器对胸腰段脊髓损伤患者的疗效分析

目的　观察胸腰段完全性脊髓损伤患者应用重心移动式截瘫步行矫形器（AGO）后对步行能力、日常生活活动能力和生存质量的临床疗效。 方法　胸腰段完全性脊髓损伤患者60例,随机分为AGO组和对照组,各30例。所有患者均进行SCI常规康复训练和处理,AGO组在常规治疗的基础上,装配AGO及进行步行训练。两组分别在入院时、装配AGO前、装配AGO后8周进行步行能力评定、ADL评定和生存质量评定。 结果 经4个月的治疗前后,进行组间比较,AGO及训练后,均可借助肘拐或步行器步行,患者10 m步行时间平均87.27s,6 min步行距离平均46.35 m;ADL能力在装配后比较治疗组明显优于对照组（P<0.01）;生存质量评分中的生理和心理方面改善具有统计学意义（P<0.05）。 结论 AGO配合系统的康复治疗对改善胸腰完全性脊髓损伤患者日常生活活动能力、步行能力及生存质量有一定效果, 值得临床进一步应用。     

遗传性痉挛性截瘫12例临床报告

目的研究遗传性痉挛性截瘫的临床表现和遗传特点。方法回顾性分析12例患者的临床资料。结果本组起病年龄为10～52岁,平均年龄22岁;35岁以下11例,35岁以上1例;单纯型9例,复杂型3例;3个家族有阳性家族史,共7例患者,散发病例5例。结论本组遗传性痉挛性截瘫患者多于青少年或青年发病,男性多于女性,单纯性较复杂型多见,遗传方式以常染色体显性遗传多见。     

调强放射治疗头-颈部仿生模型及临床应用

目的：为满足调强适形放射剂量分布和剂量大小的测试与验证。材料与方法：采用调强放射治疗仿真体模按中国人体50百分位参数，用透明全能谱组织等效材料制成，使体模具有高度仿生性、可视性，模拟了十个器官。既是人体解剖的模型，又是组织等效的放射诊断模型、放射治疗模型、医学影像训练模型。将病人的实际治疗计划移植在仿生体模上进行真实照射，用电离室测量归一点绝对剂量，用胶片剂量仪量仪测试某一层面相对剂量分布。结果：应用表明，可实现多种剂量仪(电离室、胶片剂量仪)的归一化对比。结论：该模型可用于放疗设备机械精度的校正；靶点、靶体积剂量验证；临近重要器官剂量分布测定；保证剂量不确定度小于5％，是调强适形放射治疗剂量验征的重要工具。     

Energy consumption of paraplegic locomotion using reciprocating gait orthosis

The energy cost of walking using a reciprocating gait orthosis (RGOII) with functional electrical stimulation (FES) was assessed in 14 patients with spastic complete paraplegia from six rehabilitation centres. Before and after training asing RGOII with FES, the subjects performed a progressive maximal test on an arm-crank ergometer to obtain their laboratory peak oxygen uptake heart rate (HR) and blood lactate concentration changes. At the end of the training session, oxygen uptake was measured during a walking test with orthosis at different speeds (6 min steady state at 0.1 m · s⁻¹, followed by 2-min stages at progressively increasing speeds up to exhaustion). Of the subjects 4 repeated this test using orthosis without FES. At a speed of 0.1 m · s⁻¹, represented 47 (SD 23)% of , mean HR was 137 (SD 21) beats · min⁻¹ and mean blood lactate concentration 2.4 (SD 1.4) mmol · l⁻¹. Maximal speed ranged from 0.23 to 0.5 m · s⁻¹. At maximal speed, was 91 (SD 18) % of mean HR reached 96 (SD 7)% and mean blood lactate concentration only 52 (SD 19)% of the maximal values measured during the laboratory test. Walking without electrical stimulation induced an increase in HR but there was no difference in and blood lactate compared to walking with stimulation. The training period did not result in any improvement in maximal physiological data. We concluded that the free cadence walking speed with orthosis remains much lower than that of able-bodied people or wheelchair users. The metabolic cost at a given speed is much higher even if, using a stimulation device, the cardiovascular stress is reduced.     

脊髓损伤患者E-MAG和落环锁式膝踝足矫形器的应用对比

背景：落环锁式膝踝足矫形器在较高位脊髓损伤患者中被广泛应用,但该矫形器在行走时有一个主要限制即摆动期膝关节锁定,导致患者在行走时需要通过上肢活动来补偿。目前有关不同矫形器治疗效果的对比鲜有研究。 目的：探究并对比E-MAG活跃型矫形器和落环锁式膝踝足矫形器在脊髓损伤患者步态提升中的临床效果。 方法：采用自身交叉对照研究的实验设计,观察E-MAG活跃型矫形器和落环锁式膝踝足矫形器在1例T10脊髓水平损伤患者中的应用效果。通过测量下肢的三维步态数据,对比摆动期允许膝关节屈曲、支撑期膝关节锁定和整个步态周期中膝关节均锁定两种步态的差异。 结果与结论：定性观察和运动学三维步态数据证明该患者在使用E-MAG活跃型矫形器时行走更快,更有效。尽管患者无法自主控制其膝关节,由于摆动期膝关节屈曲,支撑期膝关节锁定,使用E-MAG活跃型矫形器可以帮助患者在行走时更加安全和顺利,且需要的上肢补偿更加少。与落环锁膝式膝踝足矫形器相比,E-MAG活跃型矫形器包含站立期控制,因此会有更高的接受度和实用性     

Use of gait simulation in the evaluation of a spring-loaded knee joint orthosis for Duchenne muscular dystrophy patients

Conventional knee-ankle orthoses are still widely used in the management of lower-extremities instabilities. Often, these supporting devices maintain the leg in extension during gait and contribute to an increase in postural lumbar lordosis and thoracic kyphosis. This paper presents a new dynamic knee-ankle orthosis equipped with a spring-loaded knee mechanism which provides a more natural and comfortable gait by allowing knee flexion while insuring knee stability during stance. A mathematical model of the dynamic joint is proposed and a nonlinear optimisation technique is used to determine its parameters. A simulation of the dynamic joint behaviour over a gait cycle is presented and its main characteristics are clinically verified in a prototype fitted bilaterally to a Duchenne muscular dystrophy patient.     

Immediate effects of a controllable knee ankle foot orthosis for functional compensation of gait in patients with proximal leg weakness

Application of intermittent control of the knee joint stiffness in a knee ankle foot orthosis (KAFO) during gait is proposed. The approach combines inertial sensors and an actuator system in order to apply compensation in quadriceps weakness with a wearable device. Two methods, segment-angular rotation based and segment-angular velocity based, are analysed for the control of the knee joint state (intermittent stiffness) based on the inertial sensors signals. Protocolled tests are developed with two post-polio syndrome patients (PPS). In this study, the cases of gait with free-swinging leg and safe stance with the orthotic system are presented in terms of quantified kinematics (average peak angle of knee flexion of 50°) and evidences of reduction of frequent compensations (e.g. leg lateral movement) in post-polio syndrome patients. The results from immediate inspection indicate an important improvement of the gait patterns in two patients with proximal leg weakness by means of compensations applied by the wearable orthosis.     

Modelling the interaction of ankle-foot orthosis and foot by finite element methods to design an optimized sole in steppage gait

In this study, based on kinematics data in steppage gait, a finite element model of human gait with ankle-foot orthosis (AFO) has been proposed to optimize the role of AFO through minimizing stress in the patients' sole. The required kinetics data for the model were captured through a force plate and then analysed by 3D-DOCTOR and ANSYS software. In the proposed three-dimensional finite element model the transmitted tension in soft tissue and bones during gait was calculated. By changing the thickness and materials of different layers of sole in AFO the tension variations have been assessed. Unlike previous studies, the effect of orthosis on tension generated in bones and muscles has been dynamically and continuously modelled and the contact between AFO and sole has been considered in this model. By using the optimized sole the stress distribution has been changed by?+50.38% in the forefoot,?+15% in the midfoot and –37.79% in the hindfoot. The tension reduction in the sole can improve the effect of AFO during abnormal gait. It is possible to design each orthosis sole based on the kinetics data of each patient.     

Bionic kidney

Bionic Kidney is a project still in progress which aims at replacing all renal functions, which has been carried out in an ideal attempt to improve the overall results of Renal Replacement Therapy. It contains all the requisites for a complete rehabilitation from Uremia. As a futuristic mini-device implanted in the body, it should be a reliable support to Transplantation performance, considering the scarcity of kidney donors.     

The effect of gait approach velocity on the broken escalator phenomenon

Walking onto a stationary surface previously experienced as moving generates an after-effect commonly known as the “broken escalator” after-effect (AE). This AE represents an inappropriate expression of the locomotor adaptation necessary to step onto the moving platform (or escalator). It is characterised by two main biomechanical components, an increased gait approach velocity (GAV) and a forward trunk overshoot on gait termination. We investigated whether the trunk overshoot and other biomechanical measures are the direct inertial consequence of the increased GAV or whether these are the result of an independent adaptive mechanism. Forty-eight healthy young adults walked onto a movable sled. They performed 5 trials with the sled stationary at their preferred walking velocity (BEFORE trials), 5 with the sled moving (MOVING or adaptation trials), and 5 with the sled stationary again (AFTER trials). For the AFTER trials, subjects were divided into four groups. One group was instructed to walk slowly (“slower”), another with cueing at the BEFORE pace (“metronome”). The third group walked without cueing at the BEFORE pace (“normal”), and the fourth, fast (“faster”). We measured trunk pitch angle, trunk linear horizontal displacement, left shank pitch angular velocity and surface EMG from lower leg and trunk muscles. In the AFTER trials, an AE was observed in these biomechanical measures for all gait speeds, but these were not strongly dependent on GAV. An AE was present even when GAV was not different from that of BEFORE trials. Therefore, we conclude that, although contributary, the trunk overshoot is not the direct consequence of the increased GAV. Instead, it appears to be generated by anticipatory motor activity “just in case” the sled moves, herewith termed a “pre-emptive” postural adjustment.     

关节软骨的仿生设计

人体滑膜关节中,天然关节软骨具有多重不可替代的特殊功能和重要作用.本研究从仿生学的视角,综述关节软骨的生物化学、组织形态学、病理学特征,以及生物材料学、生物力学和生物摩擦学性质;从结构、材料、功能三个方面对关节软骨进行宏、微观层次的仿生设计,建立关节软骨仿生设计模型;为带有"软垫轴承"的新型人工关节,以及仿生人工软骨的创新设计与制造,提供理论和实践基础.