EMG-Controlled Game to Retrain Upper Extremity Muscle Activation Patterns Following Stroke

肌电图控制的游戏可重新训练中风后上肢肌肉激活模式

• 批准号: 10635090
• 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: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635090
• 关键词: Activities of Daily Living; Address; Agonist; Brachial Paresis; Caregiver Burden; Computers; Control Groups; Coupling; Data; Distal; Dose; Employment; Evaluation; Extensor; Fingers; Flexor; Hand; Impairment; Intuition; Life Style; Limb structure; Linear Models; Maps; Measures; Motion; Motor; Movement; Muscle; Neurologic; Neuromechanical Changes; Outcome; Paresis; Pattern; Performance; Physiological; Play; Principal Component Analysis; Quality of life; Randomized; Randomized, Controlled Trials; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Design; Self Care; Signal Transduction; Social Interaction; Source; Statistical Data Interpretation; Stroke; System; Testing; Therapeutic; Time; Training; Upper Extremity; Veterans; Visualization; antagonist; chronic stroke; computer game; disability; experience; follow-up; grasp; hand dysfunction; improved; motor control; motor impairment; novel; post intervention; post stroke; rehabilitative care; stroke survivor; treatment group; two-dimensional

An estimated 15,000 Veterans suffer a stroke per year, more than 75% of whom have persistent hand impairment even after a full course of rehabilitation that significantly diminishes their independence. Fundamentally, post-stroke upper limb impairments arise from altered muscle activation patterns. Thus, direct training of muscle activation patterns holds promise. Unfortunately, altered muscle activation patterns are not fully addressed in current rehabilitation. Previous efforts have been limited to training a single pair of muscles, failing to address aberrant intersegmental coupling. To address this gap, a novel EMG-controlled game system has been developed: EMG signals are mapped to the 2-dimensional motion of a cursor on a computer screen to play games. In a preliminary study, the target EMG patterns were derived from 4 nonparetic distal upper limb muscle EMGs, while games were played using 4 paretic distal upper limb muscle EMGs mapped to the target patterns, thereby promoting use of the nonparetic muscle activation patterns in the paretic limb. Twenty stroke survivors improved upper limb function assessed by the Wolf Motor Function Test Functional Abilities (WMFT FA) significantly after 9 game sessions. Objective: To expand the capacity of the EMG-controlled game system and integrate it into a full therapy paradigm. Aim 1: Improve the system. Muscle activation patterns will be characterized with nonnegative EMG amplitudes to make the game control more intuitive. The number of EMG input channels will be increased to include both proximal and distal upper limb muscles for intersegmental training. More games will be created for engagement. Feasibility of the improved system will be evaluated with neurologically intact Veterans. Aims 2-3 will evaluate the system with Veteran stroke survivors. Veterans stroke survivors will be randomly assigned to one of two groups. The treatment group will receive 9 EMG game sessions and 9 task practice therapy sessions in an alternating order. The control group will receive 18 task practice therapy sessions. Evaluation will occur at baseline, post, and 1-month follow-up. Aim 2: Determine the effect of the EMG game system plus task practice therapy on upper limb function. Hypothesis: The group training with the EMG games in conjunction with task practice therapy will improve their upper limb function assessed by WMFT FA (primary) more than the group training with dose-matched task practice therapy only. Aim 3: Determine the neuromechanical changes associated with training with the EMG-controlled games. Hypothesis: The paretic muscle activation patterns will assimilate to the nonparetic pattern only for the treatment group. The similarity will be quantified by computing the angle between the hyperplane defined by the paretic EMG patterns and the plane defined by the nonparetic EMG patterns. Impact: This research will address the current treatment gap by developing/evaluating a novel EMG-controlled game system to train muscle activation patterns, thereby directly addressing the origin of post-stroke motor impairment. This research is expected to enhance upper limb rehabilitation outcomes, contributing to improved independence and quality of life for Veterans with stroke.

估计每年有15,000名退伍军人中风，其中75％以上有持续的手 即使经过完整的康复过程，也大大减少了独立性。 从根本上讲，击球后上肢障碍是由肌肉激活模式改变引起的。因此，直接 训练肌肉激活模式有望。不幸的是，改变的肌肉激活模式不是 在当前的康复中充分解决。以前的努力仅限于训练一对肌肉， 无法解决异常的段耦合。为了解决这个差距，一种新颖的EMG控制的游戏系统 已经开发了：EMG信号映射到在计算机屏幕上光标的二维运动 玩游戏。在初步研究中，目标EMG模式源自4个非远端上部 肢体肌肉emgs，而游戏是使用映射到映射到的4个偏长的上肢肌肉EMG 靶模式，从而促进了偏肢中非准肌肉激活模式的使用。二十 中风幸存者改善了通过狼运动功能测试功能评估的上肢功能 （wmft fa）在9场比赛后有很大的意义。目的：扩大EMG控制的能力 游戏系统并将其集成到完整的治疗范式中。目标1：改进系统。肌肉激活 模式将以非负EMG振幅为特征，以使游戏控制更加直观。这 EMG输入通道的数量将增加，包括近端和远端上肢肌肉 段培训。将创建更多游戏以供参与度。改进系统的可行性将是 用神经系统完整的退伍军人评估。 AIMS 2-3将通过退伍军人中风幸存者评估该系统。 退伍军人中风幸存者将被随机分配给两组之一。治疗组将收到9 EMG游戏会议和9个任务练习治疗会议交替顺序。对照组将 接受18个任务练习治疗课程。评估将在基线，邮政和1个月的随访中进行。目的 2：确定EMG游戏系统以及任务练习疗法对上肢功能的影响。假设： 与任务练习疗法结合使用EMG游戏的小组培训将改善其上肢 通过WMFT FA评估的功能（主要）比通过剂量匹配的任务练习疗法的小组培训更多 仅有的。 AIM 3：确定与EMG控制游戏训练相关的神经力学变化。 假设：偏肌激活模式将仅用于治疗的非幼虫模式 团体。相似性将通过计算由Paretic EMG定义的超平面之间的角度来量化 模式和由非幼稚EMG模式定义的平面。影响：这项研究将解决当前 通过开发/评估新型的EMG控制的游戏系统来训练肌肉激活模式， 从而直接解决了冲程后运动障碍的起源。这项研究有望增强上层 肢体康复结果，有助于改善中风的退伍军人的独立性和生活质量。