Customizable cooperative multi-joint control to enhance walking mobility after stroke

可定制的协作多关节控制，增强中风后的行走灵活性

• 批准号: 10444685
• 负责人: Nathaniel Steven Makowski
• 金额: $ 62.92万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444685
• 关键词: Activities of Daily Living; Address; Adopted; Ankle; Bypass; Case Series; Case Study; Cervical; Clinical; Clinical Trials; Cognitive; Communities; Contracts; Data; Development; Devices; Effectiveness; Environment; Fiber; Future; Gait; Goals; Health; Hip region structure; Home; Impairment; Implant; Individual; Intervention; Intuition; Joints; Knee; Laboratories; Lead; Leg; Length; Life; Limb structure; Lower Extremity; Machine Learning; Measures; Methods; Motion; Movement; Multiple Sclerosis; Muscle; Nerve; Orthotic Devices; Paresis; Participant; Pattern; Persons; Physical therapy; Physiologic pulse; Pilot Projects; Preparation; Prosthesis; Protocols documentation; Quality of life; Rehabilitation therapy; Residual state; Safety; Scheme; Self-Help Devices; Sensory; Side; Signal Transduction; Speed; Spinal cord injury; Surface; System; Techniques; Technology; Therapeutic; Thigh structure; Time; Training; Upper Extremity; Volition; Walking; Weight; Work; base; cardiovascular health; clinical implementation; community setting; design; exoskeleton; fall risk; falls; follow-up; foot; functional independence; hand dysfunction; implanted sensor; improved; improved functioning; improved mobility; innovation; neuroprosthesis; noninvasive brain stimulation; operation; post stroke; sedentary lifestyle; sensor; social; stroke survivor; tool; treadmill; walking speed

Most stroke survivors walk slowly and are at an increased risk of falls. As a result, many adopt a sedentary lifestyle with limited functional independence that negatively impacts health and can be socially isolating. Physical therapy including advanced rehabilitation techniques have improved function, but there is no intervention available that enables stroke survivors with moderate and severe impairment to walk at speeds necessary for independent community ambulation. The long-term goal of this work is to restore stroke survivors’ ability to walk safely in the community at speeds necessary for independence. Our approach utilizes an implanted neuroprosthesis, that is a device inside the body that applies small electrical pulses to activate the nerves that cause the muscles serving multiple joints to contract in a coordinated manner for functional movement of the entire limb. The system measures volitional muscle activity and body motion and then coordinates stimulation at the different joints in the leg to produce the necessary movement for safe walking at functionally relevant speeds. The benefit of such an approach is that it is always available and does not require setup for individuals with impaired hand control. The implanted hardware also improves reliability and bypasses sensory fibers that can cause discomfort. Our team has shown in a case study that targeting muscles throughout the paretic limb can substantially improve walking speed and endurance. This study will expand this work through achieving the following Aims: 1) determining the clinical impact of an implanted multi- joint neuroprosthesis on post-stroke gait, and 2) developing and assessing an advanced neuroprosthesis cooperative control strategy. This study will implement an available neuroprosthesis that incorporates an external control unit and some external sensors in preparation for implementation of a fully implanted system that has been developed at our Center. Six participants will be implanted with devices that include 12-channels of stimulation and 2-channels for recording muscle activity. External sensors will measure limb motion. After the device is implanted, stimulation patterns will be generated and participants will undergo training to use the device. A simple triggering pattern will be created for home use and then we will implement our advanced controller in the laboratory via machine-learning techniques. Once a controller and stimulation pattern have been defined, we will determine how much faster, more safely, and easier walking is with the neuroprosthesis compared to without and confirm whether these effects are maintained over time. We will also determine if the advanced controller substantially improves walking ability over the simple triggering methods that have been previously implemented. Successful completion will confirm approaches for a post-stroke neuroprosthesis for walking and generate preliminary effect sizes for subsequent clinical trials to evaluate home and community use of a fully implanted system. This study may lead to a new clinical tool that can empower independent walking after stroke, improve quality of life, and enhance overall health of stroke survivors.

大多数中风幸存者行走缓慢，跌倒的风险增加，因此，许多人都采用这种方式。 功能独立性有限的久坐生活方式会对健康产生负面影响，并且可能会影响社交 物理治疗包括先进的康复技术可以改善功能，但没有效果。 可用干预措施使患有中度和重度损伤的中风幸存者能够快速行走 这项工作的长期目标是恢复中风。 幸存者以独立所需的速度在社区中安全行走的能力。 植入式神经假体，是一种体内装置，可施加小电脉冲来激活 导致服务于多个关节的肌肉以协调方式收缩以实现功能性的神经 该系统测量整个肢体的运动，然后测量意志肌肉活动和身体运动。 协调腿部不同关节的刺激，以产生安全行走所需的运动 这种方法的好处是始终可用并且不需要功能相关的速度。 为手部控制能力受损的人设置的植入硬件还提高了可靠性和稳定性。 我们的团队在案例研究中表明，绕过可能引起不适的感觉纤维。 整个偏瘫肢体的肌肉可以显着提高步行速度和耐力。 通过实现以下目标来扩展这项工作：1）确定植入多细胞的临床影响 关节神经假体对中风后步态的影响，以及 2) 开发和评估先进的神经假体 这项研究将实施一种可用的神经假体，该神经假体包含一个 外部控制单元和一些外部传感器，为实施完全植入的系统做准备 我们中心开发的六名参与者将被植入包含 12 通道的设备。 刺激和记录肌肉活动的 2 个通道将测量肢体运动。 设备被植入后，将生成刺激模式并接受使用该设备的培训 将为家庭使用创建一个简单的触发模式，然后我们将实现我们的高级功能。 一旦控制器和刺激模式有了，就可以通过机器学习技术在实验室中进行控制器。 定义完毕后，我们将确定神经假体的行走速度更快、更安全、更轻松 与没有相比，并确认这些效果是否会随着时间的推移而保持。我们还将确定是否会出现这种情况。 与简单的触发方法相比，先进的控制器大大提高了行走能力 先前实施的成功完成将确认中风后神经假体的方法。 步行并生成初步效果大小，以供后续临床试验评估家庭和社区 这项研究可能会带来一种新的临床工具，可以增强独立性。 中风后步行，改善生活质量，并增强中风幸存者的整体健康。