Cognitive-based Rehabilitation Platform of Hand Grasp after Spinal Cord Injury using Virtual Reality and Instrumented Wearables

使用虚拟现实和仪器化可穿戴设备的脊髓损伤后手部抓握认知康复平台

• 批准号: 10326389
• 负责人: NOAM Y. HAREL
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10326389
• 关键词: Achievement; Activities of Daily Living; Auditory; Award; Binding; Cervical; Cervical spinal cord injury; Chronic; Cluster Analysis; Cognition; Cognitive; Conscious; Coupled; Cues; Custom; Devices; Elbow; Electromyography; Environment; Esthesia; Feedback; Feeling; Future; Goals; Hand; Hybrids; Impairment; Isometric Exercise; Learning; Link; Machine Learning; Measures; Modality; Motivation; Motor; Movement; Muscle; Nervous System Trauma; Neurosciences; Outcome; Paralysed; Participant; Pathway interactions; Pattern; Perception; Performance; Persons; Physical Rehabilitation; Physical therapy; Physical therapy exercises; Positioning Attribute; Process; Quality of life; Reading; Real-Time Systems; Rehabilitation device; Rehabilitation therapy; Research; Resistance; Secure; Self-Help Devices; Sensory; Services; Shapes; Shoulder; Speed; Spinal cord injury; Stroke; Subconscious; Tactile; Techniques; Technology; Tendon structure; Testing; Therapeutic; Time; Touch sensation; Training; Translating; Traumatic Brain Injury; Upper arm; Variant; Veterans; Visual; Work; algorithm training; arm; base; cognitive enhancement; cohort; computerized; efficacy testing; exercise rehabilitation; exoskeleton; functional electrical stimulation; functional outcomes; grasp; hand dysfunction; hand grasp; hand rehabilitation; haptic feedback; haptics; improved; innovation; instrument; machine learning algorithm; motor learning; multisensory; neuromuscular; novel; operation; physical process; powered exoskeleton; powered prosthesis; rehabilitation research; research and development; sensor; sensory feedback; skills; sound; synergism; time interval; vibration; virtual; virtual reality; virtual reality environment; visual feedback; wearable device

PROJECT SUMMARY Spinal cord injury (SCI) at the cervical level impairs hand function and the ability to engage the environment. As a result, the ability to perform activities of daily living can be severely compromised, directly leading to reduced quality of life. Physical therapy is still the primary pathway to restore functional abilities after SCI. The physical rehabilitation process requires commitment by the participant to achieve meaningful gains in function. Rehabilitation approaches that are cognitively engaging can facilitate greater commitment to practice and improved movement learning. We propose to develop innovative platforms that utilize virtual reality (VR) and instrumented wearables that enhance cognitive factors during motor learning of hand grasp and reach after SCI. These factors include greater sense of agency, or perception of control, and multi-sensory feedback. Sense of agency is implicated with greater movement control, and various sensory feedback modalities (visual, audio, and haptic) are proven effective in movement training. However, these factors are not well considered in traditional physical therapy approaches. We have developed two novel cognitive-based platforms for rehabilitating grasp and reach function. We propose to test each platform in Veterans with chronic SCI at the cervical level. In Aim 1, we will investigate how our first platform, the “cognition” glove, may improve functional grasp. This glove includes force and flex sensors that provide inputs to a machine learning algorithm trained to predict when secure grasp is achieved. The glove alerts the user of secure grasp through onboard sensory modules providing visual (LED), audio (beeper), and tactile (vibrator) feedback. During training, feedback is provided at gradually shorter time-intervals to progressively induce agency based on the neuroscience principle of ‘intentional binding’. This principle suggests that with greater agency, one perceives their action (i.e., secure grasp) is more coupled in time to a sensory consequence (i.e., glove feedback). Our glove is user-ready, and now has compatibility with customized VR applications to provide enhanced sensory feedback through engaging and customized visual and sound alerts. We hypothesize that enhanced feedback in VR will produce even greater improvements in grasp performance than onboard feedback alone. In Aim 2, we investigate how Veterans with SCI may learn greater arm muscle control during virtual reaching. We have developed a “sensory” brace that provides isometric resistance to one arm to elicit electromyography (EMG) patterns that can drive a virtual arm. The person receives visual feedback from VR and muscle tendon haptic feedback from the brace during training. Tendon stimulation can elicit movement sensations that modulate muscle activation patterns. The VR feedback will provide conscious movement training cues while vibration feedback will subconsciously elicit more distinct EMG patterns based on cluster analysis. We hypothesize that the promotion of distinct EMG patterns, achieved by maximizing inter-cluster distances, will improve performance of a reach-to-touch task. Performance of both the grasp and reach task in each Aim is assessed according to metrics that describe the timing, efficiency, and accuracy of movement. For a future MERIT proposal, we intend to integrate these platforms to train better operation of powered assistive devices, including a hybrid (motor power and functional electrical stimulation of muscle) exoskeleton of the hand. Importantly, the concept of strengthening cognitive agency and learning of movement using wearable technology, multi-sensory feedback, and virtual reality during physical training will be applicable to all forms of neuromuscular impairment, including stroke and traumatic brain injury in addition to SCI. Our team is ideally positioned to take the next steps in developing, translating, and applying this technological approach, which matches the Rehabilitation Research and Development Service’s goals.

项目概要 颈部脊髓损伤 (SCI) 会损害手部功能和接触环境的能力。 结果，进行日常生活活动的能力可能会受到严重损害，直接导致能力下降 生活质量仍然是 SCI 后恢复功能的主要途径。 康复过程需要参与者承诺实现有意义的功能收益。 具有认知参与性的康复方法可以促进更大程度的练习和投入 我们建议开发利用虚拟现实（VR）和技术的创新平台。 仪器化可穿戴设备可增强 SCI 后手部抓握和触及运动学习过程中的认知因素。 这些因素包括更强的代理感或控制感，以及多感官反馈。 机构的能力与更大的运动控制和各种感觉反馈方式（视觉、音频、 和触觉）在运动训练中被证明是有效的，但是，这些因素在运动训练中并没有得到很好的考虑。 我们开发了两种新颖的基于认知的平台。 我们建议在患有慢性脊髓损伤的退伍军人中测试每个平台。 在目标 1 中，我们将研究我们的第一个平台“认知”手套如何改善功能。 这款手套包括力传感器和弯曲传感器，为经过训练的机器学习算法提供输入。 预测何时实现安全抓握，手套通过机载传感器提醒用户安全抓握。 提供视觉（LED）、音频（蜂鸣器）和触觉（振动器）反馈的模块。 以逐渐缩短的时间间隔提供，以根据神经科学原理逐步诱导能动性 这一原则表明，通过更大的代理，人们可以感知他们的行为（即安全）。 抓握）与感官结果（即手套反馈）在时间上更加耦合，我们的手套是用户就绪的，并且 现在与定制 VR 应用程序兼容，通过参与提供增强的感官反馈 我们勇敢地说，VR 中的增强反馈将产生均匀的效果。 在目标 2 中，我们研究了如何比单独的板载反馈更好地提高抓取性能。 患有 SCI 的退伍军人可以在虚拟伸展过程中学习更好的手臂肌肉控制。我们开发了一种“感觉”。 为一只手臂提供等长阻力的支架，以引发肌电图 (EMG) 模式，从而驱动 虚拟手臂接收来自 VR 的视觉反馈和来自支架的肌腱触觉反馈。 在训练过程中，肌腱刺激可以引发调节肌肉激活模式的运动感觉。 VR反馈将提供有意识的运动训练线索，而振动反馈将在潜意识中提供 基于聚类分析得出更独特的肌电图模式。 通过最大化簇间距离来实现的模式将提高触摸任务的性能。 每个目标中抓取和触及任务的表现是根据描述目标的指标进行评估的。 对于未来的 MERIT 提案，我们打算整合这些。 培训动力辅助设备更好操作的平台，包括混合动力（电机功率和功能） 重要的是，加强认知的概念。 使用可穿戴技术、多感官反馈和虚拟现实来进行运动的代理和学习 体能训练将适用于所有形式的神经肌肉损伤，包括中风和脑外伤 除了 SCI 之外，我们的团队也处于理想的位置，可以采取下一步的开发、翻译和治疗措施。 应用这种与康复研究和开发服务相匹配的技术方法 目标。