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: 10705056
• 负责人: Nathaniel Steven Makowski
• 金额: $ 63.15万
• 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/10705056
• 关键词: Activities of Daily Living; Address; Adopted; Ankle; Bypass; Case Series; Case Study; Cervical; Clinical; Clinical Trials; Cognitive; Communities; Compensation; Contracts; Data; Development; Devices; Effectiveness; Electric Stimulation; Environment; Fiber; Future; Gait; Goals; Health; Hip region structure; Home; Impairment; Implant; Individual; Intervention; Intuition; Joints; Knee; Laboratories; 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; Predisposition; Preparation; Prosthesis; Protocols documentation; Quality of life; Rehabilitation therapy; Residual state; Risk Reduction; Safety; Scheme; Self-Help Devices; Sensory; Side; Signal Transduction; Social isolation; Speed; Spinal cord injury; Surface; System; Techniques; Technology; Therapeutic; Thigh structure; Time; Training; Upper Extremity; Walking; Weight; Work; cardiovascular health; clinical implementation; community setting; design; empowerment; exoskeleton; fall risk; falls; follow-up; foot; functional improvement; functional independence; hand dysfunction; implanted sensor; improved; improved mobility; innovation; neuroprosthesis; noninvasive brain stimulation; operation; post stroke; sedentary lifestyle; sensor; 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.

大多数中风存活缓慢行走，跌倒风险增加。结果，许多人采用了 久坐的生活方式具有有限的功能独立性，会对健康产生负面影响，并且可以在社会上受到社会的影响 隔离。包括高级康复技术在内的物理疗法的功能提高了，但没有 可用的干预措施，使中风存活有中度和重度损害以速度行走 独立社区救护车所必需的。这项工作的长期目标是恢复中风 幸存者的能力以独立所需的速度安全地在社区中行走。我们的方法利用 一种植入的神经假体，它是体内的一种装置，可施加小电脉冲以激活 导致肌肉提供多个关节的神经以协调的方式收缩以进行功能 整个肢体的运动。该系统测量自愿性肌肉活动和身体运动，然后 在腿上的不同关节处进行协调刺激，以产生必要的运动以安全行走 功能相关的速度。这种方法的好处是它始终可用，不需要 为手部控制受损的人设置。植入的硬件还提高了可靠性和 绕过可能引起不适的感觉纤维。我们的团队在一个案例研究中表明了针对的 整个侧面的肌肉可以大大提高步行速度和耐力。这项研究会 通过实现以下目的来扩展这项工作：1）确定植入的多种 势后步态的联合神经假体，以及2）开发和评估晚期神经假体 合作控制策略。这项研究将实施可用的神经假体 外部控制单元和一些外部传感器，以准备实施完全植入的系统 这是在我们中心开发的。六名参与者将被植入包括12通道的设备 用于记录肌肉活动的刺激和2通道。外传感器将测量肢体运动。后 植入该设备，将产生刺激模式，参与者将接受培训以使用 设备。将创建一个简单的触发模式供家庭使用，然后我们将实施我们的高级 实验室中的控制器通过机器学习技术。一旦控制器和刺激模式具有 我们已经定义了，我们将确定神经假体的更快，更安全，更容易的步行 与没有的情况相比，并确认这些效果是否会随着时间的流逝而保持。我们还将确定是否 高级控制器大大提高了步行能力，而不是已经 以前实施。成功的完成将确认触摸后神经假体的方法 步行并产生初步效果大小，以评估家庭和社区的随后临床试验 使用完全植入的系统。这项研究可能会导致一种新的临床工具，该工具可以赋予独立的能力 中风后行走，改善生活质量并提高中风幸存者的整体健康状况。