Evaluation of robot assisted neuro-rehabilitation

机器人辅助神经康复的评价

基本信息

批准号：
7888223
负责人：
CHRISTOPHER T BEVER
金额：
--
依托单位：
BALTIMORE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2012-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7888223
关键词：
Activities of Daily Living Acute Adherence Adopted Adult Affect Age Area Behavior Therapy Behavioral Brain Brain Diseases Caring Chronic Clinical Clinical Data Data Development Devices Diagnosis Disease Distal Elbow Elements Enrollment Evaluation Exercise Functional disorder General Population Goals Grant Guidelines Hand Health Health Insurance Healthcare Systems Home Nursing Care Home environment Impairment Incidence Individual Inpatients Intervention Joint structure of shoulder region Lead Lesion Life Limb structure Literature Longevity Maps Measures Methods Mission Modeling Motor Motor Activity Motor Cortex Movement Multiple Sclerosis Muscle Nervous system structure Neurologic Neurorehabilitation Occupational Therapy Outcome Outcome Measure Parkinsonian Disorders Patients Performance Persons Phase Physical Restraint Physiology Pilot Projects Play Population Positron-Emission Tomography Publishing Quality of life Randomized Randomized Controlled Trials Recovery Recovery of Function Recurrence Rehabilitation therapy Research Resources Robot Robotics Role Shoulder Side Single-Blind Study Specificity Stroke Surrogate Markers Survivors System Testing Therapeutic Therapeutic Intervention Time Training Training Programs Transcranial magnetic stimulation Translations Traumatic Brain Injury Treatment Protocols Unemployment United States Upper Extremity Upper arm Veterans Work Wrist arm base care delivery care seeking chronic stroke constraint induced therapy cost diaries disability effective therapy follow-up functional improvement grasp hemiparesis hemiparetic stroke hospital readmission improved improved functioning kinematics loss of function motor function recovery motor impairment neuromechanism performance tests post stroke rehabilitation service response robot assistance screening skills standard of care stroke recovery treatment strategy trial comparing

项目摘要

Upper extremity dysfunction is an important part of the disability caused by stroke, the leading cause of long term disability in adults. An evolving body of research suggests that specific rehabilitation interventions can improve functioning in an impaired arm even after sustained loss of function. We and others have shown that robot assisted rehabilitation can reduce arm impairment compared to baseline. We have now shown that robot assisted rehabilitation can reduce arm impairment in a randomized, single-blind trial compared to conventional occupational therapy. Studies of robotic training and also constraint-induced therapy suggest that specific training on functional tasks may enhance to translation of training gains into improved function. We propose to study the value of adding a functional training session (which we refer to as transition to task training or TTT) to robotic training. One published study suggests that robotic training induces changes in cortical motor maps. We will conduct studies of cortical motor excitability in our patients before and after training to investigate this issue. Criteria for determining the maximum benefit of robotic training have not yet been developed. One approach would be to conduct conventional upper extremity evaluations during the course of therapy but that would significantly increase therapist time. The robots record the assistance provided to patients during each training session and we will examine whether that data might be used on an ongoing basis to evaluate patient benefit. Primary hypothesis: TTT immediately following each robotic training session leads to greater functional improvement than robot- assisted training alone for patients with chronic upper extremity dysfunction due to hemi-paretic stroke. Secondary mechanistic hypothesis: Robotic training results in alterations in cortical motor excitability as detected by transcranial magnetic stimulation. Secondary clinical hypothesis: Robot kinematic data will reflect the functional changes seen in the training and that this information can be used clinically to determine when a patient has reached maximum benefit from robotic training. In order to test these hypotheses we propose a randomized, single-blind trial comparing 36-60 minute robotic training sessions with 36 training session consisting of 45 minutes of robotic training and 15 minutes of TTT training. Outcomes will include upper arm functional assessments, the results of transcranial magnetic stimulation and robot generated kinematic data. Page 1

上肢功能障碍是中风引起的残疾的重要组成部分，成人长期残疾的原因。不断发展的研究表明康复干预措施即使在持续损失后也可以改善手臂受损的功能功能。我们和其他人表明，机器人辅助康复可以减少手臂与基线相比，损害。现在，我们已经表明机器人辅助康复可以与常规职业疗法。机器人训练以及约束诱导的治疗的研究表明有关功能任务的具体培训可能会增强培训收益转化为改进功能。我们建议研究添加功能培训课程的价值（我们是指作为向任务培训或TTT的过渡）到机器人培训。一项已发表的研究表明机器人训练会引起皮质运动图的变化。我们将进行皮质研究培训前后患者的运动兴奋性调查了这个问题。标准确定机器人训练的最大好处尚未开发出来。一种方法将在治疗过程中进行常规的上肢评估，但这将大大增加治疗师的时间。机器人记录提供的帮助每个培训期间的患者，我们将检查是否可以在持续评估患者福利的基础。主要假设：紧随其后的TTT 机器人培训课程可带来比机器人辅助培训更大的功能改进仅由于半pare肌的慢性上肢功能障碍患者而单独使用。次要机械假设：机器人训练会导致皮质运动的改变通过经颅磁刺激检测到的兴奋性。次要临床假设：机器人运动学数据将反映培训中看到的功能变化，这是信息可以在临床上使用以确定患者何时获得最大收益来自机器人训练。为了检验这些假设，我们提出了一个随机的单盲试验比较36-60分钟的机器人培训课程与36个培训课程，包括45 机器人训练和15分钟的TTT培训。结果将包括上臂功能评估，经颅磁刺激的结果和机器人产生的结果运动学数据。第1页