Browsing by Subject "Cerebral Palsy"
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Item Bench Testing of a Tunable Ankle-Foot Orthosis(2023) Jiang, TianshuCerebral palsy (CP) is the most common childhood motor disability and affects about 0.31% of children in the US. An ankle-foot orthosis (AFO) is commonly prescribed for children with CP to restore gait pattern and function. The properties of an AFO are primarily determined by two parameters: the neutral angle and the stiffness. There is no standard guidance for clinicians to determine what combination of parameters would maximize the function of an AFO. The Human/Machine Design Lab at the University of Minnesota is developing a tunable AFO emulator to help clinicians determine the effect of AFO with certain parameters immediately and the make more objective prescriptions of AFO. This project conducted a bench test on the latest design of this tool, and evaluated if the mechanisms to control the stiffness and the neutral angle of the emulator would work as intended. The mechanism for controlling the neutral angle worked as intended while the mechanism for stiffness was affected by the compliance of the AFO structure and the material of the prototype. A computer control system for the device all functions required.Item Development and Testing of Decision Support Tools in Gait Analysis(2016-04) Rozumalski, AdamObjectives Clinical gait analysis, as commonly prescribed for children with Cerebral Palsy, is a complex set of procedures which include examining data from several sources. The tools developed with this project will use that data to provide robust, repeatable, evidence-based guidance to highlight the most effective treatments for children with CP. These tools will also supply objective measures that can be included in outcome analysis. Methods Several mathematical techniques are used to find patterns within the gait date including: singular value decomposition of kinematic and kinetic data to measure gait pathology; k-means cluster analysis of those results to find recurring patterns; principal components analysis of physical exam findings to relate the gait patterns to physical function; and non-negative matrix factorization of electromyography data to measure motor control. Results The decomposition and scaling of the kinematic and kinetic data resulted in a set of indexes that are able to quantify gait pathology. The k-means cluster analysis reveals that there are repeatable patterns within the gait pathology. These patterns are related to clinical findings as calculated from principal components analysis. Clinical interpretations of motor control can be quantified as muscle synergies using non-negative matrix factorization. Interpretation These tools have proven to provide important quantitative information on treatment outcomes. When implemented in routine clinical gait analysis, these tools have the ability to provide evidence based guidance in treatment decisions.Item Evaluating and Improving the Efficacy of Ankle Foot Orthoses for Children with Cerebral Palsy(2017-01) Ries, AndrewAnkle foot orthoses (AFOs) are commonly recommended for individuals with cerebral palsy (CP) as a means to improve gait. Goals of this dissertation were to evaluate the current efficacy of AFO use for children with CP, investigate the biomechanical mechanism of how AFOs influence gait, and describe new methods for analyzing and improving AFO outcomes as they pertain to gait. Retrospective data analysis, statistical machine learning, and simulation techniques were used to achieve these goals. Data analysis revealed that the general efficacy of AFO use was poor. However, a data driven model developed through machine learning techniques suggests that efficacy can likely be improved by using the model to recommend AFO prescriptions for individuals that are predicted to improve their gait with AFO use and refrain from prescribing AFOs for individuals whose gait will not improve with AFO use. Investigations of gait efficiency and muscle function revealed new factors that could potentially be leveraged to improve the efficacy of AFO use. Finally, an AFO design redundancy between two commonly prescribed AFOs was identified, eliminating misconceptions about the efficacy of a redundant AFO design. The techniques and conclusions presented in this dissertation have the potential to significantly improve the efficacy of AFO use for children with CP.Item Nighttime Postural Care Sleep-based Outcome Measures and Education: Preparing Care Providers of Children with Cerebral Palsy(2020-02) Hutson, JenniferBACKGROUND Nighttime postural care (NTPC), an intervention using sleep-systems to position the body symmetrically during sleep, is particularly suited for children with severe Cerebral Palsy (CP); however, its impact yields mixed conclusions (Wynn & Wickham, 2009; Gericke, 2006).This variation may be due to the types of assessments used and lack of effective caregiver training. AIM of DISSERTATION: 1) examine sleep-based measures used in previous NTPC research and 2) investigate the "sleep care positioning training program’s" (Lesson A), an online NTPC training program, feasibility to educate caregivers. METHOD Completed studies include: 1) systematic literature review of NTPC sleep-based measures and 2) randomized control trial, comparing caregiver competence pre and post educational intervention. Investigators randomized 38 participants into groups (Lesson A or Lesson B) to complete differently formatted 2-hour online training (interactive video-based or self-guided web-links) on topics of NTPC evidence, risk monitoring, sleep-system types and set up, positioning methods, and outcome measures. RESULTS 1). Systematic review revealed no sleep-based measures used in past NTPC intervention research are fully suitable as outcome measures for children with severe CP. 2) Randomized trial showed Lesson A group had significantly greater change in self-rated competence for NTPC implementation (0.46 points [SE 0.17], p = 0.0078). Subjective themes describe Lesson A as a better lesson matching my learning style and Lesson B as overwhelming, not knowing what I was supposed to learn. Post-training, Lesson A and B groups correctly completed 11.85 [SE 0.83] and 12.60 [SE 0.84] of 16 positioning-tasks, not differing significantly (average difference 0.75 items [SE 0.54], p = 0.17). Professionals performed significantly better than non-professionals (F(1,92.34) = 16.62, p < 0.0001). Commonly missed tasks include “placing head/neck in neutral” and “snugging up parts”, with more error variation among Lesson B group. INTERPRETATION 1) To capture meaningful change and understand NTPC’s impact on sleep, combined use of the Sleep Disturbance Scale for Children-R and triaxial actigraph may be recommended for children with severe CP. 2) Sleep care positioning education caused increased perceived competence for health professionals and non-professionals. Post online-training caregivers accurately completed most sleep-system positioning tasks. Lesson A better prepares NTPC caregivers.