A neuroprosthesis for seated posture and balance

用于坐姿和平衡的神经假体

• 批准号: 8990788
• 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: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990788
• 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) 可导致核心躯干和髋部肌肉组织瘫痪，从而影响在伸手时稳定躯干、抵抗坐姿平衡干扰以及有效推动手动轮椅的能力。对躯干和髋部伸肌的持续刺激可以积极改变坐姿，延长双手的伸展范围，恢复直立坐姿，并改善慢速和水平表面上的轮椅推进机制。 然而，持续激活躯干和髋部伸肌对于日常生活中许多活动的动态变化的需求没有反应，并且无助于获得前倾姿势或抵抗向后定向的干扰。第一代系统还要求用户有意识地从预编程选项的固定菜单中为每个所需功能选择离散的刺激模式。本研究的目的是扩大神经假体对坐姿和平衡的功能影响，方法是：a）结合腹部和髋部屈肌，通过与伸肌的共同收缩来增强躯干刚度，b）将刺激与中风周期同步，以改善躯干硬度。轮椅推进效率，c) 提供自动扶正动作以保持直立姿势，防止跌倒和 扩展前向范围，d) 将这些方法集成到先进的传感器驱动躯干控制系统中，并使用当前可用的植入设备为过渡做好准备 适合临床传播的新技术。 我们的第二代植入刺激器遥测仪 (IST) 的植入式肌电图遥测和扩展通道数将用于实现先进的坐姿功能神经假体。两个通道的 EMG 数据将检测推进的接触阶段和返回阶段之间的转换，并在用户无需有意识的情况下在适当的刺激模式之间切换。将髋部/躯干屈肌和伸肌的连续共同激活的性能与肌肉的阶段性激活在推进机制、效率以及在水平和倾斜表面上以及在不同速度下的努力的主观感知方面进行比较。基于廉价商用无线 3D 加速计的控制系统将用于检测即将发生的向前或横向跌倒，并适当调节刺激以恢复直立姿势和坐姿平衡。有效性将从前瞻性、抗干扰性、转移的独立性和安全性、使用模式以及对在家庭和社区环境中跌倒的恐惧两方面进行评估。 来自上身肌电图和躯干加速度的补充信息将被合并到一个控制系统中，以自动调节刺激，以在各种表面和速度上自动调节和推进，而无需用户有意干预。将确定区分动态活动（例如开始、停止、崎岖或倾斜地形以及障碍物碰撞）的能力。家庭和社区的独立使用模式和措施将记录综合控制系统的效果。 该转化项目将确定一种新干预措施的可行性，以最大限度地提高坐姿稳定性、促进个人活动性并增强 SCI 退伍军人的安全性和功能独立性，并以此为未来的临床试验和整个退伍军人事务部的广泛分发确定最有效的实施方案医疗保健系统。 公共卫生相关性： 脊髓损伤 (SCI) 严重限制了获得生活机会的机会，并损害了工作、参与社交或休闲活动以及独立和富有成效的生活方式的能力。激活瘫痪的臀部和躯干肌肉可以促进健康的骨骼排列，恢复和维持直立坐姿，扩大双手的伸展范围和操纵物体的能力，防止跌倒，提高手动轮椅推进的效率，并促进转移和其他日常生活活动。该项目很重要，因为它指定了一个用于恢复坐姿和平衡的综合控制系统，可以通过以任务相关的方式加强躯干来改善坐姿功能，而无需用户有意识地努力。它直接适用于残疾退伍军人的健康和福祉 在 SCI 人群中所占比例过高。