A multimodal intervention to improve manual dexterity in subacute stroke survivors

提高亚急性中风幸存者的手灵巧度的多模式干预

• 批准号: 10285270
• 负责人: Derek Kamper
• 金额: $ 21.51万
• 依托单位: NORTH CAROLINA STATE UNIVERSITY RALEIGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-10 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10285270
• 关键词: Area; Articular Range of Motion; Biological; Cellular Phone; Clinical; Clinical assessments; Combined Modality Therapy; Complex; Custom; Development; Devices; Digit structure; Distal; Dose; Electric Stimulation; Electrodes; Evaluation; Exhibits; Failure; Fatigue; Feedback; Fiber; Fingers; Freedom; Frequencies; Goals; Hand; Hand functions; Hour; Human; Impairment; Individual; Individuation; Intervention; Isometric Exercise; Joints; Learning; Manuals; Matched Group; Measures; Medical; Modality; Motion; Motivation; Motor; Movement; Muscle; Music; Nature; Nerve; Neural Pathways; Neurologic; Neuronal Plasticity; Occupational Therapy; Outcome; Participant; Pathway interactions; Pattern; Performance; Phase; Play; Production; Public Health; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Resistance; Sensory; Shoes; Stroke; Structure of ulnar nerve; Surface; System; Task Performances; Techniques; Tendon structure; Therapeutic Intervention; Thumb structure; Training; Translating; Upper Extremity; Visual; Work; Wrist; clinical practice; density; dexterity; effectiveness evaluation; electric impedance; exoskeleton; finger movement; functional electrical stimulation; hand dysfunction; hand rehabilitation; improved; median nerve; motor control; motor impairment; multi-component intervention; multimodality; neuroregulation; novel; novel therapeutic intervention; novel therapeutics; post stroke; social situation; stroke survivor; success; tool; virtual; virtual reality

ABSTRACT The hands constitute the primary means by which humans interface with the external world. Increasingly, these interactions involve objects such as tools that require significant manual dexterity to use properly. Impairment of fine motor control of the hand, such as commonly occurs after stroke, can profoundly impact object manipulation, thereby substantially reducing functionality of the hand, and of the entire upper limb in general. Clinical tools to support rehabilitation of fine manual dexterity are limited despite the high frequency of hand impairment in stroke survivors and the importance of the hand to overall function and daily living. Thus, this study will focus on the evaluation of a novel, multimodal treatment approach in which functional electrical stimulation (FES) is combined with use of a soft hand exoskeleton to promote active training of independent digit movement after stroke. These modalities will be used in a coordinated manner, with FES helping to excite appropriate motor units to guide neuroplasticity while the exoskeleton inhibits unwanted flexion of other digits to assist task performance. The FES will target nerves rather muscles to enable excitation of a greater range of muscles and to reduce fatigue. The soft exoskeleton will allow full active range of motion of all digits with minimal impedance when unactuated. Together they will be used in conjunction with the Actuated Virtual Keyboard (AVK) virtual reality platform. With this system, flexion of the user’s digits results in “playing” displayed keys. The virtual nature of the keys facilitates repetitive practice with the proper level of challenge to maximize learning. For example, the amount of joint flexion required to play a key can be easily adjusted during a training session, as well as the level of FES and exoskeleton assistance provided to the user. As the user progresses, the exoskeleton can also be used to resist intended movement to provide further challenge. In these ways, task difficulty is matched to user ability. The system provide visual and audio feedback of success or failure of key strikes, as well as recording of finger movements producing errors, to inform the user and therapist. Stroke survivors in the subacute phase of recovery will complete 18 training sessions with this novel therapy paradigm over 6 weeks. A matched group of stroke survivors will participate in 18 training sessions of similar duration and intensity, but employing standard therapy techniques focused on the hand. Evaluation sessions will be conducted prior to initiation of training, midway through the training, after the completion of all training sessions, and one month later. The ability of participants to created independent movement and isometric force with each digit will be quantified; a high-density electrode array will be used to measure activation patterns of targeted hand muscles. It is anticipated that the group receiving the multimodal training with the AVK system will exhibit significantly greater improvement on clinical assessments of motor control of the hand, and in digit individuation and independent activation of muscles and muscle compartments. Encouraging outcomes for the novel therapeutic intervention introduced in this study would have direct ramifications for clinical practice.

抽象的 手构成人类与外部世界互动的主要手段。日益， 这些相互作用涉及对象，例如需要大量手动灵活性才能正确使用的工具。 手动控制的损害受损，例如中风后通常发生，会深刻影响对象 操纵，从而大大降低了手的功能，以及整个上肢的功能。 尽管高频频率很高 中风生存的障碍以及手对整体功能和日常生活的重要性。 这是这项研究将重点介绍一种新型多模式治疗方法的评估，其中功能 电刺激（FES）通过使用软手外骨骼结合起来，以促进主动训练 中风后独立数字运动。这些方式将以FES的协调方式使用 在外骨骼抑制不必要的屈曲时，帮助兴奋适当的电机单元引导神经可塑性 其他数字以协助任务绩效。 FES将靶向神经而不是肌肉，以激发 肌肉范围更大并减轻疲劳。软外骨骼将允许所有人的全部活动范围 未发动时的数字最小的阻抗。它们将共同使用 虚拟键盘（AVK）虚拟现实平台。使用此系统，用户数字的屈曲导致“播放” 显示键。钥匙的虚拟性质促进了重复的实践，以适当的挑战水平 最大学习。例如，玩钥匙所需的关节屈曲量可以很容易地调整 培训课程以及提供给用户的FES和外骨骼帮助的水平。作为用户 进展，外骨骼也可用于抵抗预期的运动以提供进一步的挑战。在这些 方式，任务困难与用户能力匹配。该系统提供了成功的视觉和音频反馈或 关键罢工的失败以及记录产生错误的手指运动，以告知用户和治疗师。 恢复亚急性阶段中的中风存活率将通过这种新型疗法完成18次训练课程 范式超过6周。一组匹配的中风幸存者将参加18个类似的培训课程 持续时间和强度，但采用标准治疗技术集中在手上。评估会议将 在完成所有培训后，请在进行培训之前进行培训之前进行培训 会议，一个月后。参与者创造独立运动和等距力的能力 每个数字将被量化；高密度电极阵列将用于测量 有针对性的手肌。预计接受AVK系统接受多模式培训的小组将 对手的运动控制和数字的临床评估表现出明显的改善 肌肉和肌肉室的个体和独立激活。鼓励结果 在这项研究中引入的新型热干预将对临床实践产生直接影响。