Effect of Upper Arm Support on the Hemiparetic Arm

上臂支撑对偏瘫手臂的影响

• 批准号: 9234156
• 负责人: Matthew Williams
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9234156
• 关键词: Activities of Daily Living; Address; Afghanistan; Area; Beer; Caregivers; Chronic; Clinical; Conflict (Psychology); Dependence; Development; Devices; Drops; Effectiveness; Elbow; Electric Stimulation; Equilibrium; Exhibits; FPS-FES Oncogene; Fingers; Flexor; Force of Gravity; Forearm; Future; Generations; Goals; Hand; Hand functions; Impairment; Individual; Intervention; Iraq; Isometric Exercise; Joints; Kinetics; Lead; Lifting; Limb structure; Location; Measures; Motion; Motor; Movement; Muscle; Nervous System Trauma; Paresis; Patients; Pattern; Performance; Persons; Population; Recruitment Activity; Research; Robotics; Self-Help Devices; Shoulder; Signal Transduction; Spastic; Stroke; Support System; System; Testing; Time; Translations; Traumatic Brain Injury; Upper Extremity; Upper arm; Veterans; Walking; Wheelchairs; Withdrawal; Work; Wrist; arm; arm function; arm paresis; chronic stroke; clinically relevant; design; experimental study; health administration; hemiparesis; hemiparetic stroke; improved; kinematics; light weight; meetings; novel; post stroke; robot assistance; robotic device; social; spasticity; stroke survivor; synergism

Moderate to severe hemiparesis as a result of stroke can have a significant impact upon many common activities of daily living (ADLs), resulting in significant dependence on caregivers. One common occurrence in stroke is the development of abnormal muscle synergies where the elbow, wrist, and fingers involuntarily flex and close when the patient exerts effort to lift the arm. This results in a loss of reach area and closing of the hand, greatly impairing its use. However, it has been shown that when the arm is supported and an outside force is used to lift the arm, this involuntary activity is not elicited. Any intervention to restore arm and hand function in individuals with hemiparesis due to severe to moderate stroke must first address the alleviation of this shoulder-elbow flexion synergy. The objective of the proposed work is to demonstrate the effectiveness of active support of the arm proximal to the elbow to assist shoulder abduction with the long-term goal of developing a small, worn, robotic assistance system. By using an external device rather than the person's voluntary effort to counter gravity, the effects of the shoulder-elbow flexion synergy will be significantly reduced; potentially allowing the user's retained voluntary movement control and strength to be effective. While earlier work has used arm support at the forearm or wrist to show a reduction in flexion synergy, this arrangement is not amenable to a worn device. The research proposed will be achieved through meeting two Specific Aims. The first is to characterize the kinetics, kinematics, and functional capabilities of the post-stroke hemiparetic arm while being supported. This will consist of experiments to test subjects' abilities to produce force isometrically, reach throughout the workspace in front of them, and open the hand with and without arm support provided by a commercially available robotic arm. The second Aim will be to quantify the changes in muscle activity as a result of reduction in abnormal flexion synergy afforded by proximal arm support. This Aim will serve to measure the timing and magnitude changes of EMG signals of the arm flexors as they relate to shoulder muscle EMG activity and quantify and demonstrate the changes in muscle activity that lead to a reduction in abnormal flexion synergy. Similar to Aim 1, EMG patterns will be compared between the gravity supported and the unsupported conditions. The work proposed represents a novel placement of arm support to reduce flexion synergies. This work is critical to the development of future arm assistance systems for individuals with hemiparesis as a result of stroke. By moving the location of the support closer to the body, a lightweight, wearable, clinically deployable, and user acceptable arm support system can be developed in later projects.

中风的中度至重度偏瘫可能对许多人产生重大影响 日常生活的常见活动（ADL），导致对护理人员的严重依赖。一 中风中常见的发生是肘部的异常肌肉协同作用的发展 当患者努力抬起手臂时，手腕和手指不由自主地弯曲并关闭。这 导致伸手障碍区域的损失和手关闭，从而极大地损害了其使用。但是，已经 表明，当手臂受到支撑并使用外部力量来举起手臂时，此非自愿 活动没有引起。任何干预措施以恢复患有 由于严重至中度的偏瘫，必须首先解决此肩肘的缓解 屈曲协同作用。 拟议工作的目的是证明主动支持的有效性 靠近肘部，以协助肩膀绑架，以发展一个小的目标 磨损，机器人援助系统。通过使用外部设备而不是人的自愿努力 为了应对重力，将大大降低肩肘屈曲协同作用的影响； 有可能允许用户保留的自愿运动控制和力量有效。 虽然较早的工作使用前臂或手腕上使用了手臂支撑，以显示屈曲的减少 协同作用，这种布置不适合磨损的设备。 提出的研究将通过达到两个具体目标来实现。首先是 表征触觉后肢体臂的动力学，运动学和功能功能 同时得到支持。这将包括测试受试者产生力能力的实验 偶像地说，伸到它们面前的整个工作空间，并没有和没有 由市售机器人手臂提供的手臂支撑。第二个目标是量化 肌肉活动的变化是由于减少异常屈曲协同作用而导致的变化 近端手臂支撑。该目标将有助于测量EMG的时机和幅度变化 手臂屈肌的信号与肩部肌肉EMG活动相关并进行量化和 证明肌肉活动的变化导致异常屈曲协同作用。 与AIM 1相似，将比较受支持的重力和不支持的重力之间的EMG模式 状况。 提出的工作代表了臂支撑的新型位置，以减少屈曲协同作用。这 工作对于为偏瘫的个体开发未来的手臂援助系统至关重要 由于中风。通过将支撑位置移动到靠近身体的位置，轻巧，可穿戴， 可以在以后的项目中开发临床部署和用户可接受的ARM支持系统。