A neuroprosthesis for seated posture and balance

用于坐姿和平衡的神经假体

• 批准号: 8486090
• 负责人: RONALD J TRIOLO
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8486090
• 关键词: Abdomen; Acceleration; Activities of Daily Living; Clinical; Clinical Trials; Communities; Conscious; Data; Disabled Persons; Environment; Equilibrium; Fall prevention; Flexor; Future; Generations; Health; Healthcare Systems; Hip region structure; Home environment; Implant; Intervention; Lateral; Leisure Activities; Life; Life Style; Manual wheelchair; Measures; Mechanics; Muscle; Paralysed; Pattern; Perception; Performance; Personal Satisfaction; Phase; Population; Posture; Preparation; Procedures; Recruitment Activity; Safety; Self Stimulation; Signal Transduction; Specific qualifier value; Speed; Spinal cord injury; Stimulus; Stroke; Surface; System; Telemetry; Veterans; Wheelchair propulsion; Wheelchairs; Wireless Technology; Work; base; falls; fear of falling; implantable device; improved; neuroprosthesis; new technology; programs; public health relevance; sensor; skeletal; social; telemetering

DESCRIPTION (provided by applicant): Spinal cord injury (SCI) can result in paralysis of the core trunk and hip musculature which compromises the ability to stabilize the torso while reaching, resist disturbances to sitting balance, and efficiently propel a manual wheelchair. Constant stimulation of the trunk and hip extensor muscles can positively alter seated posture, extend bimanual reach, restore erect sitting, and improve wheelchair propulsion mechanics at slow speeds and on level surfaces. However, continuously activating the trunk and hip extensors is unresponsive to the dynamically changing demands of many activities of daily living and does not contribute to attaining forward leaning postures or resisting rearward directed disturbances. First-generation systems also require users to intentionally select a discrete pattern of stimulation for each desired function from a fixed menu of pre-programmed options. The purpose of this study is to expand the functional impact of neuroprostheses for seated posture and balance by a) incorporating the abdominal and hip flexor muscles to enhance trunk stiffness through co-contraction with the extensors, b) synchronizing stimulation with the stroke cycle to improve wheelchair propulsion efficiency, c) providing automatic righting actions to maintain upright posture, prevent falls and extend forward reach, and d) integrating these approaches into an advanced sensor-driven trunk control system with currently available implantable devices in preparation for transitioning to new technologies suitable for clinical dissemination. The implanted EMG telemetry and expanded channel count of our second-generation implanted stimulator-telemeter (IST) will be utilized to implement advanced neuroprostheses for seated function. Two channels of EMG data will detect transitions between contact and return phases of propulsion and switch between appropriate stimulus patterns without conscious effort by the user. Performance of continuous co-activation of the hip/trunk flexor and extensor muscles will be compared to phasic activation of the muscles in terms of propulsion mechanics, efficiency, and subjective perception of effort on level and inclined surfaces and at various speeds. Control systems based on an inexpensive commercially available wireless 3D accelerometer will be implemented to detect impending forward or lateral falls and appropriately modulate stimulation to restore upright posture and sitting balance. Efficacy will be evaluated in terms of forward reach, rejection of disturbances, independence and safety of transfers, and both patterns of usage and fear of falling in the home and community environments. Complementary information from upper body EMG and trunk accelerations will be combined into a single control system to automatically regulate stimulation for self-righting and propulsion over various surfaces and speeds without intentional intervention by the user. Ability to discriminate between dynamic activities such as starts, stops, bumpy or inclined terrain and obstacle collisions will be determined. Usage patterns and measures of independence in the home and community will document the effects of the comprehensive control system. This translational project will establish the feasibility of a new intervention fr maximizing seated stability, facilitating personal mobility and enhancing the safety and functional independence of veterans with SCI, and in so doing define the most effective implementation for future clinical trials and widespread distribution throughout the VA healthcare system. PUBLIC HEALTH RELEVANCE: Spinal cord injury (SCI) significantly restricts access to life opportunities and compromises the ability to work, engage in social or leisure activities, and assume an independent and productive lifestyle. Activating the paralyzed hip and trunk muscles can promote healthy skeletal alignment, restore and maintain erect sitting postures, extend bimanual reach and the ability manipulate objects, prevent falls, improve the efficiency of manual wheelchair propulsion and facilitate transfers and other activities of daily living. This project is important because it specifies a comprehensive control system for restoring sitting posture and balance that can improve seated function by stiffening the trunk in task-dependent manners without conscious effort by the user. It is directly applicable to the health and well-being of disabled veterans who are over-represented in the SCI population.

描述（由申请人提供）： 脊髓损伤（SCI）会导致核心躯干和髋部肌肉瘫痪，从而损害稳定躯干同时稳定躯干的能力，抵抗干扰坐姿平衡并有效推动手动轮椅。持续刺激躯干和髋关节伸肌可以积极改变座位的姿势，扩展双层触及范围，恢复直立的坐姿，并在慢速和水平表面上改善轮椅推进力学。 但是，不断激活躯干和髋关节伸肌对许多日常生活活动的动态需求无反应，并且不会有助于达到前进的倾斜姿势或抵抗向后的有向扰动。第一代系统还要求用户从固定的预编程选项菜单中有意为每个所需功能选择一个离散的刺激模式。这项研究的目的是通过a）通过与伸肌共同结合腹部和髋关节屈肌肌肉来扩大神经假体对坐姿和平衡的功能影响，以增强躯干的刚度，b）与中风循环同步刺激，以提高轮椅推进效率，以防止稳定的速度，以防止稳定的姿势，c）保持稳定性，c）降低了自动的右后候，c） 扩展向前覆盖范围，d）将这些方法与当前可植入的设备相结合到高级传感器驱动的后备箱控制系统中，以准备过渡 适用于适合临床传播的新技术。 我们的第二代植入刺激器 - 凝集仪（IST）的植入的EMG遥测和扩展的通道计数将用于实现座椅功能的先进神经phip。 EMG数据的两个通道将检测推进的接触和返回阶段之间的过渡，并在没有用户有意识的努力的情况下在适当的刺激模式之间切换。将臀部/躯干屈肌和伸肌肌肉连续共激活的性能与肌肉的阶段激活相比，就推进力学，效率和对水平和倾斜表面和各种速度的努力的主观感知而言。将实施基于廉价的市售无线3D加速度计的控制系统，以检测前向前或侧向跌落，并适当调节刺激以恢复直立的姿势和坐姿平衡。疗效将根据远期覆盖率，拒绝骚乱，转移的独立性和安全性以及使用方式以及对家庭和社区环境中跌倒的恐惧进行评估。 来自上半身EMG和躯干加速度的互补信息将合并为单个控制系统，以自动调节各种表面和速度的自构和推进的刺激，而无需用户故意干预。将确定能够区分动态活动，例如开始，停止，颠簸或倾斜的地形和障碍碰撞的能力。家庭和社区中独立性的使用模式和衡量标准将记录综合控制系统的影响。 这个翻译项目将确定最大化座椅稳定性的新干预措施的可行性，促进个人流动性，并增强退伍军人的安全性和功能独立性，并因此确定了整个VA医疗保健系统的最有效的临床试验和广泛分布的最有效实施。 公共卫生相关性： 脊髓损伤（SCI）显着限制了获得生活机会的机会，并损害了工作，从事社交或休闲活动的能力，并采取独立和生产的生活方式。激活瘫痪的髋关节和躯干肌肉可以促进健康的骨骼对齐，恢复和维持直立的坐姿，扩展双层触及范围以及能力操纵物体，防止跌落，提高手动轮椅推进的效率，并促进转盘和其他日常生活活动。该项目很重要，因为它指定了一个综合控制系统，用于恢复坐姿姿势和平衡，可以通过在没有用户有意识的努力的情况下以任务依赖的方式来提高座椅功能。它直接适用于残疾退伍军人的健康和福祉 在SCI人群中代表过多。