矫形辅具支撑相内多模步态稳定性检测及分析技术研究
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摘要
随着康复工程技术的发展,结合矫形器与步行器的矫形辅具在各类下肢运动功能障碍的治疗与康复中发挥出了越来越重要的作用。矫形辅具的助行效果会因其对关节约束模态条件的不同而有很大差别。如何在不同约束模态下准确全面地分析评估其助行效果已经成为指导矫形辅具有效使用的急待解决的研究课题。目前的步态分析技术更多关注的是生理学及运动学效果,缺乏稳定性特征对动作状态的评价和回馈,尤其是缺乏对包含全部下肢动作信息的支撑相稳定性特征的深入研究,因此往往使矫形辅具难以达到理想助行效果,这已成为困扰矫形辅具发展的瓶颈问题。
本文分别从空间稳定性和力学稳定性的角度研究了矫形辅具助行过程中支撑相内的四种膝关节约束模态特征,旨在找出可表征不同矫形模式稳定性的敏感特征。研究中首先构建了基于步行器的无线测力系统,并利用传统线性方法和偏最小二乘回归方法对测力系统分别进行了静态标定,有关误差检验结果表明,偏最小二乘回归方法可有效降低测量中的交叉干扰,其最大交叉干扰为8.2%,远低于传统线性方法的19.96%。通过对15名受试者的膝部矫形辅具四模态助行实验,获得相关以柄反作用矢量表征的上肢三维力学信息,并进一步转化成单位步态周期支撑相内的步行器倾翻指数(WTI)和人体虚拟重心(VCG),分别以WTI和VCG作为力学稳定性和空间稳定性的特征向量,采用两种方法对四矫形模态进行分类:其一是利用判别分析法进行模态判别,其最高正确判别率可达93.33%;其二是用支持向量机方法进行模式分类,其最高识别率达91.67%。通过对判别分析和支持向量机方法的分析结果进行比较,证实这两种方法均可有效甄别出稳定性在支撑相内的矫形模态特征,但对于不同的稳定性特征会具有不同的敏感性。
本研究结果表明,通过可靠的检测和分析方法,支撑相内的VCG与WTI可以作为区分不同矫形模态的敏感特征,用于针对性的康复指标制定,全面评价矫形辅具助行的步态效果,并有望在未来某些关节约束疾病的早期辅助检测和诊断中得到应用。
With the development of rehabilitation engineering, orthosis assistive device combining orthosis and walker has played an important role in treatment and rehabilitation for dyskinesia of lower limbs. The assisted walking effects with orthosis assistive device vary obviously with the difference in joint constraint modal condition. How to analyze and assess these assisted walking effects accurately and comprehensively under different constraint modal conditions is the problem that should be solved as soon as possible. At present, gait analysis technology paid more attention on physiology and kinematics effect and lacked assessment and feedback of movement states with stability features, especially the stability features in stancephase which include all movement information of lower limbs. This deficit made orthosis assistive devices hardly to meet ideal assisted walking effect, which has been the bottleneck to the development of orthosis assistive devices.
This thesis studied the spatial and mechanical stability features from four knee joint constraint modals during walking assisted with orthosis assistive device in order to find out those sensitive features which could describe stability in different orthopedic modals. Firstly, a wireless dynamometer system of walker was constructed and calibrated with traditional linear method and partial least-squares regression method. The result of error check suggested that the largest cross talk of partial least-squares regression method was 8.2%, which was much lower than 19.96% from traditional linear method. From the experiments of four modal assisted walking with orthosis assistive device of 15 subjects, three-dimensional mechanical information of upper limbs characterized by handle reaction vector were collected and converted into Walker Tipping Index (WTI) and Virtual Center of Gravity (VCG) in stance phase of gait cycle. WTI and VCG were separately used as feature vector of spatial and mechanical stability to classify four orthopedic models by two methods. One was discriminant analysi with the biggest recognition rate of 93.33%. Another was support vector machine with the biggest recognition of 91.67%. After comparing the results from discriminant analysis and support vector machine, it was suggested that both methods could identify orthopedic modal features of stability in satnce phase, but their sensitivity to various stability features was different.
According to the results in this thesis, with reliable detection and analysis methods, VCG and WTI in stance phase can be sensitive features to distinguish different orthopedic models, which will be used to make targeted rehabilitation protocol and comprehensively assess the gait effect of walking assisted with orthosis assistive device. It will also likely to be applied in early aid detection and diagnosis in some joint constraint disease in the future.
本文分别从空间稳定性和力学稳定性的角度研究了矫形辅具助行过程中支撑相内的四种膝关节约束模态特征,旨在找出可表征不同矫形模式稳定性的敏感特征。研究中首先构建了基于步行器的无线测力系统,并利用传统线性方法和偏最小二乘回归方法对测力系统分别进行了静态标定,有关误差检验结果表明,偏最小二乘回归方法可有效降低测量中的交叉干扰,其最大交叉干扰为8.2%,远低于传统线性方法的19.96%。通过对15名受试者的膝部矫形辅具四模态助行实验,获得相关以柄反作用矢量表征的上肢三维力学信息,并进一步转化成单位步态周期支撑相内的步行器倾翻指数(WTI)和人体虚拟重心(VCG),分别以WTI和VCG作为力学稳定性和空间稳定性的特征向量,采用两种方法对四矫形模态进行分类:其一是利用判别分析法进行模态判别,其最高正确判别率可达93.33%;其二是用支持向量机方法进行模式分类,其最高识别率达91.67%。通过对判别分析和支持向量机方法的分析结果进行比较,证实这两种方法均可有效甄别出稳定性在支撑相内的矫形模态特征,但对于不同的稳定性特征会具有不同的敏感性。
本研究结果表明,通过可靠的检测和分析方法,支撑相内的VCG与WTI可以作为区分不同矫形模态的敏感特征,用于针对性的康复指标制定,全面评价矫形辅具助行的步态效果,并有望在未来某些关节约束疾病的早期辅助检测和诊断中得到应用。
With the development of rehabilitation engineering, orthosis assistive device combining orthosis and walker has played an important role in treatment and rehabilitation for dyskinesia of lower limbs. The assisted walking effects with orthosis assistive device vary obviously with the difference in joint constraint modal condition. How to analyze and assess these assisted walking effects accurately and comprehensively under different constraint modal conditions is the problem that should be solved as soon as possible. At present, gait analysis technology paid more attention on physiology and kinematics effect and lacked assessment and feedback of movement states with stability features, especially the stability features in stancephase which include all movement information of lower limbs. This deficit made orthosis assistive devices hardly to meet ideal assisted walking effect, which has been the bottleneck to the development of orthosis assistive devices.
This thesis studied the spatial and mechanical stability features from four knee joint constraint modals during walking assisted with orthosis assistive device in order to find out those sensitive features which could describe stability in different orthopedic modals. Firstly, a wireless dynamometer system of walker was constructed and calibrated with traditional linear method and partial least-squares regression method. The result of error check suggested that the largest cross talk of partial least-squares regression method was 8.2%, which was much lower than 19.96% from traditional linear method. From the experiments of four modal assisted walking with orthosis assistive device of 15 subjects, three-dimensional mechanical information of upper limbs characterized by handle reaction vector were collected and converted into Walker Tipping Index (WTI) and Virtual Center of Gravity (VCG) in stance phase of gait cycle. WTI and VCG were separately used as feature vector of spatial and mechanical stability to classify four orthopedic models by two methods. One was discriminant analysi with the biggest recognition rate of 93.33%. Another was support vector machine with the biggest recognition of 91.67%. After comparing the results from discriminant analysis and support vector machine, it was suggested that both methods could identify orthopedic modal features of stability in satnce phase, but their sensitivity to various stability features was different.
According to the results in this thesis, with reliable detection and analysis methods, VCG and WTI in stance phase can be sensitive features to distinguish different orthopedic models, which will be used to make targeted rehabilitation protocol and comprehensively assess the gait effect of walking assisted with orthosis assistive device. It will also likely to be applied in early aid detection and diagnosis in some joint constraint disease in the future.
引文
[1] Khasnabis C.That determine the needs for orthotics services. ISPO Consensus Conference on Appropriate Lower Limb Orthotics for Developing Countries, Hanoi, 2006
[2]刘志泉,我国肢体残疾人概况和假肢生产供应情势,第二届北京国际康复论坛论文集,北京:国家康复辅具研究中心,2008,82
[3]毕联阳,唐占英,钱雪华等,下肢矫形器的应用特点,中国组织工程研究与临床康复,2008,12(17):3317
[4]李高峰,方新,矫形器产品的功能考量,中国组织工程与临床康复,2006,10(37):134~135
[5]谭先军,下肢矫形器的原理剖析,社会福利,2003,12(1):55~56
[6]黄海晶,王志彬,金鸿宾等,助行器的演变与发展,中国矫形外科杂志,2006,14(18):1397~1399
[7] Prentide Am. The double-labelled water method for measuring energy expenditure: technical recommendations for usein humans. A consensus report by the international dietary energy consultancy working group. International Atomic Energy Agency, Vienna, 1990, 21: 241~251
[8] Patterson SM, Krant DS, Montgomery LC, et al. Automated physical acitivity monitoring: validation and comparision with physiological and self-report measures. Psychophysiology, 1993, 30: 296~305
[9] Chilsan Taber S, Rimm EB, Stanmper MJ, et al. Reproducibility and validity of a selfadminstered physical activity questionnaire for male health professionals. Epidemiology, 1996, 7: 81~86
[10]Black AE, Coward WA, Cole TJ, et al. Human energy expenditure in affluent societies: an analysis of 574 doubly-labelled water measurements. Eur J Clin Nutr, 1996, 50: 72~92
[11]高怀民,翁长水,余增志等,膝踝矫形器对脑卒中偏瘫患者步行周期的影响,中国康复医学杂志,2000,15(1):47~48
[12]Gfohler M, Angeli T, Eberharter T, et al. Test bed with force-measuring crank for static and dynamic investigations on cyling by means of functional electrical stimulation. IEEE Trans Neural Syst Rehabil Eng. 2001, 9(2): 169~180
[13]Popovic D, Radulovic M, Schwirtlich L, et al. Automatic vs handcontrolled walking of paraplegics. Med Eng Phys. 2003, 25(1): 63~73
[14]Ramdharry GM, Marsden JF, Day BL, et al. De-stabilizing and training effects of foot orthoses in multiple sclerosis. Mult Scler. 2006 Apr; 12(2): 219~226.
[15]Bleyenheuft C, Caty G, Lejeune T, et al. Assessment of the Chignon dynamic ankle-foot orthosis using instrumented gait analysis in hemiparetic adults. Ann Readapt Med Phys. 2008 Apr; 51(3): 154~160
[16]Donaldson N, Yu CH. A study of handle reaction vector (HRV) in walker FES standing. Proc Inst Mech Eng. 1996, 211(1): 81~94
[17]Bachschmidt RA, Harris GF, Simoneau GG. Walker-assisted gait in rehabilitation: A atudy of biomechanics and instrumentation. IEEE Trans Neural Syst Rehabil Eng. 2001, 9(1): 96~105
[18]Ming D, Wan BK, Hu Y, et al. Dynamical Measurement Method of Handle Reaction Vector for FES-Assisted Paraplegic Walking. Transaction of Tianjin University. 2005, 11(5): 318~321
[19]Blyth TS. Algebra through practice: a collection of problems in algebra with solutions. New York: Cambridge University Press, 1984. 72~93
[20]Sawyer WW, An engineering approach to linear algebra. Cambridge University Press, 1972. 27~75
[21]Mostow George. Linear algebra. New York: McGraw-Hill, 1969. 102~131
[22]俞阿龙,径向基函数神经网络在多维力传感器标定中的应用,计量学报,2006,27(1):46~49
[23]秦浩,林志娟,陈景武等,偏最小二乘回归原理、分析步骤及程序,数理医药学杂志,2007,20(4):450~451
[24]王斌,矫形器在军队中的应用,中国康复理论与实践,2004,10(19):569
[25]Duffus A, Wood J. Standing and walking for the T6 paraplegic Physiotherapy. 1983, 69(2): 45~46
[26]Kralj A, Bajd T, Turk R, et al. Gait restoration in paraplegic patients: a feasibility demonstration using multichannel surface electrode FES. Rehabil R D. 1983, 20(1): 3~20
[27]Crosbie WJ, Nicole AC, Reciprocal aided gait in paraplegia. Paraplegia, 1990, 28(6): 353~363
[28]Wainapel SF, Langer-Broas BJ, Patak RJ. Alternate four-point sweep-through gait: A technique for patients with combined neuromuscular and visual impairments: case reports. Phys Med Rehabil. 1999, 78(2): 163~165
[29]Babic J, Karcnik T, Bajd T. Stability analysis of four-point walking. Gait Posture. 2001, 14(1): 56~60
[30]Schroeder ET.AAPP product report: walkers. Amer Assoc Retired Persons. 1991,1(7): 1~15
[31]Crosbie J.Kinematics of walking frame ambulation. Clin. Biomech. 1993, 8(1): 31~36
[32]Pardo RD, Deathe AB, Winter DA. Walker user risk index. Amer J Phys Med Rehab. 1993, 72(5): 301~305
[33]Deathe AB, Pardo RD, Winter DA. Stability of walking frames. J Rehab Res Dev. 1996,33(1): 30~35
[34]Deathe AB, Hayes KC, Winter DA. The biomechanics of canes, crutches, and walkers. Crit Rev Phys Rehab Med. 1993, 5(1), 15~29
[35]Nabizadeh SA, Hardee TB, Towler MA, et al. Technical considerations in the selection and performance of walkers. J Burn Care Rehab.1993, 14(2): 182~188
[36]Rose J, Gamble JG.. Human Walking. Baltimore: Williams and Wilkins, 1994. 25~56
[37]Winter DA. Biomechanics and Motor Control of Human Movement. New York: Wiley, 1990. 36~49
[38]Chandler FR, Clauser CE, McConville JT, et al. Investigation of inertial properties of the human body. Ohio: AMRL Tech Rep, 1975. 98~173
[39]Richman J S, Moorman J R. Physiological time-series analysis using approximate entropy and sample entropy. AJP Heart and Circulatory Physiology, 2000, 278(6): 2039~2049
[40]张学工,统计学习理论的本质,北京:清华大学出版社,2000
[41]边肇祺等,模式识别,北京:清华大学出版社,1998
[42]李国正,王猛,曾华军译,支持向量机导论,北京:电子工业出版社,2004
[43]Vapnik V N. The Nature of Statistical Learning Theory, New York: Springer-Verlag, 1995
[2]刘志泉,我国肢体残疾人概况和假肢生产供应情势,第二届北京国际康复论坛论文集,北京:国家康复辅具研究中心,2008,82
[3]毕联阳,唐占英,钱雪华等,下肢矫形器的应用特点,中国组织工程研究与临床康复,2008,12(17):3317
[4]李高峰,方新,矫形器产品的功能考量,中国组织工程与临床康复,2006,10(37):134~135
[5]谭先军,下肢矫形器的原理剖析,社会福利,2003,12(1):55~56
[6]黄海晶,王志彬,金鸿宾等,助行器的演变与发展,中国矫形外科杂志,2006,14(18):1397~1399
[7] Prentide Am. The double-labelled water method for measuring energy expenditure: technical recommendations for usein humans. A consensus report by the international dietary energy consultancy working group. International Atomic Energy Agency, Vienna, 1990, 21: 241~251
[8] Patterson SM, Krant DS, Montgomery LC, et al. Automated physical acitivity monitoring: validation and comparision with physiological and self-report measures. Psychophysiology, 1993, 30: 296~305
[9] Chilsan Taber S, Rimm EB, Stanmper MJ, et al. Reproducibility and validity of a selfadminstered physical activity questionnaire for male health professionals. Epidemiology, 1996, 7: 81~86
[10]Black AE, Coward WA, Cole TJ, et al. Human energy expenditure in affluent societies: an analysis of 574 doubly-labelled water measurements. Eur J Clin Nutr, 1996, 50: 72~92
[11]高怀民,翁长水,余增志等,膝踝矫形器对脑卒中偏瘫患者步行周期的影响,中国康复医学杂志,2000,15(1):47~48
[12]Gfohler M, Angeli T, Eberharter T, et al. Test bed with force-measuring crank for static and dynamic investigations on cyling by means of functional electrical stimulation. IEEE Trans Neural Syst Rehabil Eng. 2001, 9(2): 169~180
[13]Popovic D, Radulovic M, Schwirtlich L, et al. Automatic vs handcontrolled walking of paraplegics. Med Eng Phys. 2003, 25(1): 63~73
[14]Ramdharry GM, Marsden JF, Day BL, et al. De-stabilizing and training effects of foot orthoses in multiple sclerosis. Mult Scler. 2006 Apr; 12(2): 219~226.
[15]Bleyenheuft C, Caty G, Lejeune T, et al. Assessment of the Chignon dynamic ankle-foot orthosis using instrumented gait analysis in hemiparetic adults. Ann Readapt Med Phys. 2008 Apr; 51(3): 154~160
[16]Donaldson N, Yu CH. A study of handle reaction vector (HRV) in walker FES standing. Proc Inst Mech Eng. 1996, 211(1): 81~94
[17]Bachschmidt RA, Harris GF, Simoneau GG. Walker-assisted gait in rehabilitation: A atudy of biomechanics and instrumentation. IEEE Trans Neural Syst Rehabil Eng. 2001, 9(1): 96~105
[18]Ming D, Wan BK, Hu Y, et al. Dynamical Measurement Method of Handle Reaction Vector for FES-Assisted Paraplegic Walking. Transaction of Tianjin University. 2005, 11(5): 318~321
[19]Blyth TS. Algebra through practice: a collection of problems in algebra with solutions. New York: Cambridge University Press, 1984. 72~93
[20]Sawyer WW, An engineering approach to linear algebra. Cambridge University Press, 1972. 27~75
[21]Mostow George. Linear algebra. New York: McGraw-Hill, 1969. 102~131
[22]俞阿龙,径向基函数神经网络在多维力传感器标定中的应用,计量学报,2006,27(1):46~49
[23]秦浩,林志娟,陈景武等,偏最小二乘回归原理、分析步骤及程序,数理医药学杂志,2007,20(4):450~451
[24]王斌,矫形器在军队中的应用,中国康复理论与实践,2004,10(19):569
[25]Duffus A, Wood J. Standing and walking for the T6 paraplegic Physiotherapy. 1983, 69(2): 45~46
[26]Kralj A, Bajd T, Turk R, et al. Gait restoration in paraplegic patients: a feasibility demonstration using multichannel surface electrode FES. Rehabil R D. 1983, 20(1): 3~20
[27]Crosbie WJ, Nicole AC, Reciprocal aided gait in paraplegia. Paraplegia, 1990, 28(6): 353~363
[28]Wainapel SF, Langer-Broas BJ, Patak RJ. Alternate four-point sweep-through gait: A technique for patients with combined neuromuscular and visual impairments: case reports. Phys Med Rehabil. 1999, 78(2): 163~165
[29]Babic J, Karcnik T, Bajd T. Stability analysis of four-point walking. Gait Posture. 2001, 14(1): 56~60
[30]Schroeder ET.AAPP product report: walkers. Amer Assoc Retired Persons. 1991,1(7): 1~15
[31]Crosbie J.Kinematics of walking frame ambulation. Clin. Biomech. 1993, 8(1): 31~36
[32]Pardo RD, Deathe AB, Winter DA. Walker user risk index. Amer J Phys Med Rehab. 1993, 72(5): 301~305
[33]Deathe AB, Pardo RD, Winter DA. Stability of walking frames. J Rehab Res Dev. 1996,33(1): 30~35
[34]Deathe AB, Hayes KC, Winter DA. The biomechanics of canes, crutches, and walkers. Crit Rev Phys Rehab Med. 1993, 5(1), 15~29
[35]Nabizadeh SA, Hardee TB, Towler MA, et al. Technical considerations in the selection and performance of walkers. J Burn Care Rehab.1993, 14(2): 182~188
[36]Rose J, Gamble JG.. Human Walking. Baltimore: Williams and Wilkins, 1994. 25~56
[37]Winter DA. Biomechanics and Motor Control of Human Movement. New York: Wiley, 1990. 36~49
[38]Chandler FR, Clauser CE, McConville JT, et al. Investigation of inertial properties of the human body. Ohio: AMRL Tech Rep, 1975. 98~173
[39]Richman J S, Moorman J R. Physiological time-series analysis using approximate entropy and sample entropy. AJP Heart and Circulatory Physiology, 2000, 278(6): 2039~2049
[40]张学工,统计学习理论的本质,北京:清华大学出版社,2000
[41]边肇祺等,模式识别,北京:清华大学出版社,1998
[42]李国正,王猛,曾华军译,支持向量机导论,北京:电子工业出版社,2004
[43]Vapnik V N. The Nature of Statistical Learning Theory, New York: Springer-Verlag, 1995