Abstract
Mobility impairments due to injury or disease have a significant impact on quality of life. Consequently, development of effective treatments to restore or replace lost function is an important societal challenge. In current clinical practice, a treatment plan is often selected from a standard menu of options rather than customized to the unique characteristics of the patient. Furthermore, the treatment selection process is normally based on subjective clinical experience rather than objective prediction of post-treatment function. The net result is treatment methods that are less effective than desired at restoring lost function. This paper discusses the possible use of personalized neuromusculoskeletal computer models to improve customization, objectivity, and ultimately effectiveness of treatments for mobility impairments. The discussion is based on information gathered from academic and industrial research sites throughout Europe, and both clinical and technical aspects of personalized neuromusculoskeletal modeling are explored. On the clinical front, we discuss the purpose and process of personalized neuromusculoskeletal modeling, the application of personalized models to clinical problems, and gaps in clinical application. On the technical front, we discuss current capabilities of personalized neuromusculoskeletal models along with technical gaps that limit future clinical application. We conclude by summarizing recommendations for future research efforts that would allow personalized neuromusculoskeletal models to make the greatest impact possible on treatment design for mobility impairments.
Highlights
Mobility involves walking, stair climbing, posture, balance, manipulation, transfers, and other locomotion tasks and is central to qualify of life
The final treatment plan is usually selected based on subjective clinical experience rather than on objective prediction of post-treatment function developed from patient data
Clinical process of personalized modeling How should personalized neuromusculoskeletal models be used to predict functional outcome for various treatment plans under consideration? Expanded from ideas presented by researchers at the Rizzoli Orthopedic Institute in Bologna, Italy, and Dr Bart Koopman at the University of Twente in Enschede, the Netherlands, we propose a three-step process for treatment design using personalized models: 1) Model preparation steps:
Summary
Stair climbing, posture, balance, manipulation, transfers, and other locomotion tasks and is central to qualify of life. The stated goal of the project is to “create an ICT-based patientspecific surgical navigation system that helps the surgeon safely reach the optimal functional result for the patient and is a user friendly training facility for the surgeons.” In this project, the researchers proposed to use personalized neuromusculoskeletal models as part of a three-step treatment design process. Patients have varied and unique clinical presentations, making stereotypical treatment planning ineffective For this reason, personalized neuromusculoskeletal models, especially those that are able to model the neurological limitations (e.g., muscle spasticity) of the patient, could play a valuable role in predicting the outcome of complex multi-level surgeries that are performed on these patients [25,26,27]. Identification of novel approaches that utilize only existing data collection capabilities, as well as development of new experimental techniques, will be essential if clinicians are to gain confidence in treatment plans designed with personalized neuromusculoskeletal models
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