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.

中风导致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），导致对照顾者的严重依赖。一 中风中常见的现象是肘部、 当患者用力抬起手臂时，手腕和手指会不自觉地弯曲和闭合。这 导致触及范围的损失和手的闭合，极大地损害了其使用。然而，已经 表明，当手臂受到支撑并使用外力抬起手臂时，这种不自觉的运动 没有引发活动。任何恢复手臂和手部功能的干预措施 重度至中度中风引起的偏瘫必须首先解决肩肘的缓解问题 屈曲协同作用。 拟议工作的目标是展示手臂积极支持的有效性 靠近肘部以协助肩部外展，长期目标是发展小、 磨损的机器人辅助系统。通过使用外部设备而不是人的自愿努力 为了对抗重力，肩肘屈曲协同作用的效果会明显减弱； 潜在地使用户保留的自愿运动控制和力量变得有效。 虽然早期的工作使用前臂或手腕处的手臂支撑来显示屈曲的减少 协同作用，这种布置不适合磨损的设备。 拟议的研究将通过满足两个具体目标来实现。第一个是 描述中风后偏瘫手臂的动力学、运动学和功能能力 在受到支持的同时。这将包括测试受试者产生力量的能力的实验 等距地伸手穿过他们面前的工作空间，并张开手（有或没有） 手臂支撑由商用机械臂提供。第二个目标是量化 由于异常屈曲协同作用的减少而导致的肌肉活动变化 近端手臂支撑。该目标将用于测量肌电图的时间和幅度变化 手臂屈肌的信号，因为它们与肩部肌肉肌电图活动相关，并量化和 证明肌肉活动的变化导致异常屈曲协同作用的减少。 与目标 1 类似，将比较有重力支撑和无支撑的肌电图模式 状况。 所提出的工作代表了一种新颖的手臂支撑放置方式，以减少屈曲协同作用。这 工作对于开发未来偏瘫患者手臂援助系统至关重要 由于中风。通过将支撑件的位置移至更靠近身体的位置，打造出一种轻质、可穿戴、 可以在以后的项目中开发临床可部署且用户可接受的手臂支撑系统。