Feasibility of Using Maestro Hand Exoskeleton in Post-stroke Hand Rehabilitation to Improve Joint Coordination

使用 Maestro 手部外骨骼进行中风后手部康复以提高关节协调性的可行性

• 批准号: 10368417
• 负责人: Na Jin Seo
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10368417
• 关键词: Activities of Daily Living; Acute; Address; Animals; Articular Range of Motion; Caring; Educational Status; Ensure; Feedback; Financial compensation; Finger joint structure; Fingers; Freedom; Future; Goals; Hand; Hand functions; Human; Impairment; Individuation; Intervention; Joints; Laws; Left; Leisures; Macaca; Measures; Monkeys; Movement; Neurologic; Outcome; Participant; Patient Participation; Patients; Pattern; Performance; Quality of life; Recovery; Rehabilitation therapy; Research; Robot; Robotics; Self Care; Stroke; Study models; System; Testing; Time; Torque; Training; Upper Extremity; Veterans; Work; arm; assistive robot; base; cost estimate; design; disability; effectiveness evaluation; exoskeleton; follow-up; grasp; hand dysfunction; hand rehabilitation; hand therapy; improved; individual patient; innovation; inpatient service; joint mobilization; military veteran; novel; patient safety; post stroke; prevent; programs; recruit; rehabilitative care; robot control; robot rehabilitation; stroke model; stroke patient; stroke survivor; tool

Estimated 15,000 Veterans suffer a stroke each year. Stroke is a leading cause of long-term disability in the US. New strokes cost an estimated $111 million for acute inpatient care, $75 million for post-acute inpatient care, and $88 million for follow-up care in the first six months post-stroke in VHA. Yet, more than two thirds of stroke survivors have persistent hand impairment that significantly diminishes their abilities to perform activities of daily living. While it is known that training for healthy movement patterns is critical especially early on in rehabilitation, precise control of multiple finger joints simultaneously is not possible in current therapy. Controlling finger joint movements is challenging since the human hand has more than 20 degrees of freedom (DOF) densely located in a small space. There exist robots for hand rehabilitation that train for gross grasping and finger individuation. However, current robots have limited DOF and cannot control finger joint torques, so these systems are unable to deliver training that ensures healthy movement patterns. Thus, there is lack of tools for delivering training that ensures healthy movement pattern and prevents compensatory movements. With a lack of joint-level training tool, patients are either left with compensatory patterns, or worse, have no recovery of hand movements. With the long-term goal of improving hand rehabilitation, we have designed a robotic tool called the Maestro hand exoskeleton. Maestro’s design features enable delivery of versatile interventions for patients with a wide range of impairments in various stages of recovery. This innovation represents a substantial advancement from current rehabilitation robotic tools by providing high-intensity, task-based training with real time modulation of assistance and difficulty level ensuring patient participation and task saliency. The objective of this project is to develop novel controllers with promising neurological basis for training correct movement patterns in stroke patients. Specifically, (1) compensation avoidance (CA) controller will apply joint torques to push the patients away from the compensatory joint coordination, only interfering with the movements once the subject initiates a compensatory movement strategy. (2) Task assistance (TA) controller will apply assistive joint torques to directly help stroke patients achieve finger tasks with correct coordination. For both controllers, the torques in the finger joints will be modulated to match the individual patient’s ability, impairment, and progression throughout the training via robot control program. Four and nine Veteran subacute stroke survivors with moderate to severe hand impairment and with some ability to move fingers will participate in the testing for Aim1 and Aim 2, respectively. Aim 1 will involve one session and Aim 2 will involve four sessions of experimentation for each participant. Aim 1: Develop and determine feasibility of CA and TA controllers. Hypothesis: CA and TA controllers are feasible, as seen by (1) patient safety and (2) abilities for TA and CA controller to move the finger joints toward the desired trajectories and away from compensatory coordination, respectively. Aim 2: Determine feasibility of training using CA and TA controllers in subacute stroke. Hypothesis: Joint coordination will improve over a training session more with CA controller for patients with moderate impairment, and more with TA controller for patients with severe impairment. Impact: This research will develop a novel training tool to improve finger joint coordination, thereby addressing the unmet need in the current rehabilitation. Future studies will use the developed Maestro controllers to elucidate underlying principles of practice-related neuro-recovery post stroke per impairment level and determine the effectiveness of Maestro on improving finger joint coordination and hand function. As a result, this research is expected to enhance hand function, contributing to improved independence and quality of life for Veterans with stroke.

据估计，每年有 15,000 名退伍军人中风，是导致美国长期残疾的主要原因。 新发中风的急性住院护理费用估计为 1.11 亿美元，急性后住院护理费用为 7500 万美元， 8800 万美元用于 VHA 中风后前六个月的后续护理 然而，超过三分之二的中风患者。 幸存者的手部持续受损，严重削弱了他们进行日常活动的能力 虽然众所周知，健康运动模式的训练至关重要，尤其是在康复早期， 目前的治疗方法无法同时精确控制多个手指关节。 由于人手拥有超过 20 个密集的自由度 (DOF)，因此运动具有挑战性 在狭小的空间内，存在用于手部康复的机器人，可以训练粗略的抓握和手指的个性化。 然而，当前的机器人自由度有限，无法控制指关节扭矩，因此这些系统无法 提供确保健康运动模式的培训 因此，缺乏提供培训的工具。 确保健康的运动模式并防止缺乏关节级训练的代偿性运动。 使用工具后，患者要么留下代偿模式，要么更糟，手部运动无法恢复。 为了改善手部康复的长期目标，我们设计了一种名为 Maestro hand 的机器人工具 Maestro 的设计特点能够为各种类型的患者提供多种干预措施。 这项创新代表了当前的重大进步。 康复机器人工具，通过提供高强度、基于任务的训练和实时调节辅助 确保患者参与和任务显着性的难度水平 该项目的目标是发展。 新型控制器具有良好的神经学基础，可用于训练中风患者的正确运动模式。 具体来说，（1）补偿避免（CA）控制器将施加关节扭矩以将患者推离 补偿性关节协调，仅在受试者启动时干扰运动 (2) 任务辅助 (TA) 控制器将直接施加辅助关节扭矩 帮助中风患者正确协调完成手指任务 对于两个控制器，手指的扭矩。 在整个治疗过程中，关节将被调节以匹配个体患者的能力、损伤和进展 通过机器人控制程序进行训练的四名和九名患有中度至重度手部的退伍军人亚急性中风幸存者。 障碍和具有一定移动手指能力的人将分别参加 Aim1 和 Aim 2 的测试。 目标 1 将涉及每个参与者的一次实验，目标​​ 2 将涉及四次实验： 开发并确定 CA 和 TA 控制器的可行性 假设：CA 和 TA 控制器是可行的，因为。 通过 (1) 患者安全和 (2) TA 和 CA 控制器将指关节移向所需位置的能力来观察 目标 2：确定训练的可行性。 在亚急性中风中使用 CA 和 TA 控制器 假设：联合协调性将通过训练得到改善。 对于中度损伤的患者，更多地使用 CA 控制器进行会话，对于患者，更多地使用 TA 控制器进行会话 影响：这项研究将开发一种新的训练工具来改善手指关节。 协调，从而解决当前康复中未满足的需求。 开发 Maestro 控制器来阐明中风后与实践相关的神经恢复的基本原理 每个损伤级别并确定 Maestro 在改善手指关节协调性和手部的有效性 因此，这项研究有望增强手部功能，有助于提高独立性。 和中风退伍军人的生活质量。