Developing and Determining Feasibility of a Novel Upper Extremity Robotic Exoskeleton to Track and Target Unwanted Joint Synergies during Repetitive Task Training in Stroke Survivors

开发并确定新型上肢机器人外骨骼的可行性，以跟踪和瞄准中风幸存者重复任务训练期间不需要的关节协同作用

• 批准号: 10805748
• 负责人: Brittney C Muir
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10805748
• 关键词: 3-Dimensional; Activities of Daily Living; Acute; Address; Admission activity; Adult; Affect; Aftercare; Area; Clinical; Data; Development; Ensure; Evaluation; Grant; Health; Intervention; Ischemic Stroke; Joints; Kinetics; Laws; Manuals; Measurement; Mediating; Modality; Motion; Motor; Motor Activity; Movement; Neurologic; Orthotic Devices; Participant; Patients; Pattern; Performance; Quality of life; Recovery; Recreation; Rehabilitation therapy; Research; Robot; Robotics; Stroke; System; Techniques; Testing; Torque; Training; Training Activity; Traumatic Brain Injury; Upper Extremity; Veterans; Veterans Health Administration; Vocation; acute stroke; arm; arm movement; disability; exoskeleton; improved; joint mobilization; kinematics; military veteran; neural; novel; patient engagement; patient safety; programs; recruit; rehabilitation research; research and development; robot exoskeleton; robotic system; stroke incidence; stroke patient; stroke survivor; synergism; tool

Stroke causes significant long-term disability and the incidence of stroke in our Veteran population is high with approximately 6,000 VA admissions for acute ischemic stroke per year in 2014. Rehabilitation programs that improve upper extremity function have the potential to impact Veterans’ activities of daily living and improve their vocation, recreation, and overall quality of life. Repetitive task training (RTT) is active practice of a task-specific motor activity and is more effective than simple joint movements in improving upper extremity function after treatment. However, RTT can be draining for both the clinician and the patient as it requires the participant to complete many repetitions of the same task and those repetitions can be difficult to accomplish with appropriate technique. Previous research has shown that to significantly affect patient recovery it is critical to initiate RTT in the acute and sub-acute stages, maintain health joint coordination, and keep the patients engaged and challenged. Robot-mediated RTT has the potential to facilitate the clinical delivery of proven rehabilitation programs to our Veterans in need and recently a new exoskeleton has been developed, called Harmony, with the ability to deliver bimanual 3D arm therapy. Currently there a lack of tools for delivering RTT in the early stages of recovery while maintaining joint coordination during 3D arm movement and ensuring that assistance commensurate with patient abilities. Therefore, the objective of this project is to develop novel controllers that use promising neurological basis for training to facilitate repetitive task training while ensuring correct movement patterns in acute and sub-acute stage stroke patients. Specifically, (1) synergy avoidance (SA) controller will apply joint torques to push the patients away from the maladaptive joint coordination, only interfering with the movements once the subject initiates such a maladaptive movement strategy. (2) Task assistance (TA) controller will apply assistive joint torques to directly help stroke patients achieve 3D RTT activities with correct coordination at a high intensity (repetitions/session). Aim 1: to develop and determine feasibility of RTT controller. H1: SA and TA controllers are feasible, as seen by (1) patient safety and (2) abilities of TA and SA controllers to move upper-body joints along task trajectories and away from synergistic coordination, respectively. Up to five sub-acute stroke survivors will complete RTT activities with both the SA and TA controllers. H1 will be considered supported if the applied torque meets the requirements defined by the control law and the feasibility criteria are met for the TA and SA controllers in two consecutive patients. Aim 2: determine feasibility of controllers and quantify change in joint coordination during 3-week intervention. H2a: a 3-week long intervention is feasible with both the controllers as seen by (1) patient safety and (2) abilities for TA and SA controllers to move the upper-body joints toward the desired trajectories for 3D RTT activities while avoiding synergistic compensatory coordination. H2b: the robotic system will accurately track joint synergies in acute stroke patients before and after a 3-week intervention, revealing any change in compensatory strategies. Two acute stroke survivors will be recruited. Participants will be assigned to either the TA or SA controller and will complete high repetitions of reaching tasks once per day while wearing the Harmony exoskeleton for three weeks. Joint kinematic and kinetic data will be recorded by the robotic system in all the sessions. Kinematic data will also be recorded in the evaluation sessions before and after the 3-week intervention in two modalities: robot in zero-torque mode and using an infrared motion tracking system. Joint synergies will be evaluated for the two acute stroke patients before and after a three-week intervention. Hypotheses will be considered supported if there is an acceptably low rate of error between the kinematic measurements of the robotic system and the motion capture system. New rehabilitation programs that improve upper extremity functional performance have the potential to impact Veterans’ ADL and improve their vocation, recreation, and overall quality of life. New rehabilitation programs that improve upper extremity function have the potential to impact Veterans’ ADLs and improve their vocation, recreation, and overall quality of life.

中风会引起严重的长期残疾，而我们的资深人口中，中风的事件很高， 2014年，每年大约有6,000名VA入院。 改善上肢功能有可能影响退伍军人的日常生活活动并改善他们的活动 职业，娱乐和整体生活质量。重复的任务培训（RTT）是特定于任务的积极练习 运动活动，比简单的关节运动在改善上肢功能之后更有效 治疗。但是，临床和患者的RTT可能会排出，因为它要求参与者 完成相同任务的许多重复，这些重复很难通过适当的 技术。先前的研究表明，要显着影响患者的康复，至关重要的是启动RTT 急性和亚急性阶段，维持健康联合协调，并保持患者的参与和挑战。 机器人介导的RTT有可能促进向我们的临床提供验证的康复计划 有需要的退伍军人，最近已经开发了一种新的外骨骼，称为Harmony，能够交付 双人3D手臂疗法。目前，缺乏在恢复的早期阶段提供RTT的工具 在3D ARM移动期间保持联合协调并确保与患者相称的援助 能力。因此，该项目的目的是开发使用有希望的神经学基础的新型控制器 培训以促进重复的任务培训，同时确保急性和急性的正确运动模式 阶段中风患者。具体而言，（1）避免协同作用（SA）控制器将应用关节扭矩以推动 患者远离适应不良的关节协调，仅一旦受试者就会干扰运动 启动这种适应不良的运动策略。 （2）任务援助（TA）控制器将应用辅助联合 扭矩直接帮助中风患者以高强度正确协调实现3D RTT活动 （重复/会话）。目标1：开发和确定RTT控制器的可行性。 H1：SA和TA控制器是 可行，如（1）患者安全性以及（2）TA和SA控制器的能力沿着上身接头移动上身关节 任务轨迹分别远离协同协调。多达五个亚急性中风生存将 使用SA和TA控制器完成RTT活动。如果施加的扭矩，H1将被视为支持 满足控制法所定义的要求，并满足TA和SA控制器的可行性标准 在两名连续患者中。目标2：确定控制器的可行性并量化联合协调的变化 在3周的干预期间。 H2A：3周长的干预是可行的，这两个控制器都是可行的，如（1） 患者安全性以及（2）TA和SA控制器将上身关节移向所需的能力 3D RTT活动的轨迹，同时避免协同补偿协调。 H2B：机器人系统 将在三周之前和之后准确地跟踪急性中风患者的关节协同作用，从而揭示任何 补偿策略的变化。将招募两个急性中风生存。参与者将被分配给 TA或SA控制器要么可以完成每天完成任务的高度重复 和谐外骨骼三个星期。机器人系统将记录关节运动学和动力学数据 所有会议。运动学数据还将记录在3周之前和之后的评估课程中 干预两种方式：以零气压模式的机器人和使用红外运动跟踪系统。联合的 三周干预之前和之后，将对两名急性中风患者的协同作用进行评估。 如果运动学之间存在可接受的低误差率，则将考虑假设受到支持 机器人系统和运动捕获系统的测量。改进的新康复计划 上肢功能性能有可能影响退伍军人的ADL并改善投票， 娱乐和整体生活质量。改善上肢功能的新康复计划具有 影响退伍军人的ADL并改善他们的投票，娱乐和整体生活质量的潜力。