Myoelectrolytically controlled device in acute rehabilitation after stroke

肌电控制装置在中风后急性康复中的应用

• 批准号: 10705555
• 负责人: Ahlam Salameh
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705555
• 关键词: Action Research; Activities of Daily Living; Acute; Address; Affect; Aging; Brain; Brain Injuries; Career Mobility; Certification; Clinical; Clinical Trials; Complex; Data; Devices; Early treatment; Elbow; Electroencephalography; Electromyography; Evaluation; Exhibits; Functional Magnetic Resonance Imaging; Future; Goals; Grant; Hand; Impairment; Individual; Injury; Intervention; Ischemic Stroke; Joints; Knowledge; Laboratories; Lead; Left; Measures; Medical; Medical center; Mentors; Methods; Motor; Motor Evoked Potentials; Movement; Muscle; Muscle Tonus; Near-Infrared Spectroscopy; Neuronal Plasticity; Neurons; Orthotic Devices; Outcome; Outcome Measure; Paralysed; Paresis; Patients; Phase; Population; Preparation; Principal Investigator; Process; Protocols documentation; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Research Personnel; Scientist; Self-Help Devices; Signal Transduction; Stroke; Structure; Technology; Testing; Tissues; Training; Transcranial magnetic stimulation; United States Department of Veterans Affairs; Upper Extremity; Veterans; acute stroke; arm; arm function; arm movement; arm paresis; career; chronic stroke; clinical outcome measures; critical period; design; disability; experience; follow-up; functional outcomes; gain of function; hemodynamics; improved; innovation; joint mobilization; military veteran; motor control; motor deficit; motor function recovery; motor learning; movement practice; neural; neuroimaging; neurological rehabilitation; neuromechanism; neurophysiology; new technology; novel; post stroke; recruit; repaired; response; satisfaction; skills; standard care; stroke rehabilitation; stroke survivor; study population; tissue repair; tool; wearable device

Almost 30 % of stroke survivors with initial severe arm impairment fail to achieve sufficient recovery of arm function to enable them to independently perform activities of daily living. Functional deficits can be improved by combining rehabilitation with promising new technologies. Myoelectrically controlled devices utilize the weak electrical signals generated by the affected muscles and amplify them to activate a motor in the device. The movement of the motor augments their own volitional movement in the joint associated with that motor. Hence, the device provides the user the support needed to move their paretic arm. a-Myopro is an adjustable myoelectrically controlled orthosis that facilitates movement of the paretic hand and elbow by providing assistance through four modes of movements. The a-Myopro user can train with a single mode, or multiple modes can be combined to allow for more complex training of individual or multi-joint movements. Thus, a- Myopro provides stroke subjects who have limited arm function a unique movement training paradigm that allows them to volitionally practice isolated arm movements that they otherwise cannot practice on their own. During the first weeks after the onset of stroke, the injured brain undergoes several neural mechanisms, a process known as neuroplasticity, that intend to reorganize the neural connectivity and repair the damaged tissue around the injury region. Several studies have revealed that rehabilitation during this acute period would enhance the functional outcome of the paretic arm presumably by modulating the heightened neuroplastic mechanism. Specifically, it has been suggested that novel interventions that enhance neuroplastic mechanisms of recovery are particularly needed for stroke survivors who are severely impaired. The rationale of this CDA1 proposal is to explore if the myoelectrically controlled device a-Myopro can be added to the acute rehabilitation of stroke subjects with severe arm deficits. The study will also investigate if application of a-Myopro would lead greater enhancement of clinical outcomes compared to standard care. Because neuroplasticity is heightened in the acute phase, the study aims to correlate the neurophysiological changes with the enhancement gained as a result of practicing with a-Myopro in this population. Thus, this study will test the premise that adding practice with a-Myopro to the acute rehabilitation of subjects with severe arm impairment acts as a novel rehabilitative tool that promotes the neuroplastic mechanisms of recovery to enhance clinical outcomes for these subjects. Preliminary data on chronic stroke subjects provides support for the central premise of this study. We have found that individuals with chronic stroke who receive 18 sessions of individualized practice using Myopro exhibit improvements in the clinical outcomes of the paretic arm. In this proposed study, to test my premise in the acute rehabilitation phase, ten subjects with acute ischemic stroke (2 – 14 days post stroke) will receive 18 sessions of individualized practice using a-Myopro. The improvements in upper extremity impairment and function measured by clinical measures will be compared to previously reported standard care results. Neurophysiological and neuroimaging tools will be used to collect information on the neuroplastic changes during the study period. This CDA-1 will inform whether implementation of a- Myopro in acute rehabilitation is feasible and leads to improvement in arm function in the study population. This project is ideal for me during my transition into clinical neurorehabilitation field. Specifically, with the help of my primary mentor and comprehensive mentoring team, I will begin to be trained in (1) clinical outcome measures for stroke subjects, (2) neurophysiological and neuroimaging tool in neurorehabilitation research, (3) clinical best practices in stroke and preparation for clinical trial management and (4) aspects to become an independent clinical researcher. My project is highly integrated with my career goal of becoming a leading investigator in clinical neurorehabilitation within the VA medical center.

几乎30％的中风存活率具有最初的严重手臂损伤，无法实现足够的手臂恢复 功能使他们能够独立地进行日常生活活动。功能定义可以改进 通过将康复与承诺新技术相结合。肌电控制设备利用弱 受影响肌肉产生的电信号并将其放大以激活设备中的电动机。这 电动机的运动增强了与该电动机相关的关节中自己的自愿运动。因此， 该设备为用户提供移动其侧臂所需的支持。 a-myopro是可调的 肌电控制的矫形器，通过提供促进偏心手和肘部运动的矫形器。 通过四种运动方式的帮助。 A-Myopro用户可以通过单个模式进行训练或多个 可以组合模式以允许对单个或多关节运动进行更复杂的培训。那，A- Myopro提供的中风主题有限的手臂功能是独特的运动训练范式， 使他们能够自愿练习孤立的手臂运动，原本无法自行练习。 在中风发作后的头几周，受伤的大脑经历了几种神经机制 被称为神经可塑性的过程，即重组神经元连接并修复受损的意图 围绕受伤区域的组织。几项研究表明，在这个急性期间的康复将 大概通过调节增强的神经塑性来增强毛线臂的功能结果 机构。特别是，已经提出了增强神经塑性的新型干预措施 对于严重损害的中风存活率，恢复机制尤其需要恢复机制。 该CDA1提案的基本原理是探索肌电控制设备是否可以是myopro 除了严重手臂的急性康复中，急性康复。该研究还将调查是否是否 与标准护理相比，A-yopro的应用将导致更大的临床结果增强。 由于神经可塑性在急性阶段提高，因此该研究旨在使神经生理学相关 随着A-Myopro在该人群中的实践而获得的增强变化。那，这个 研究将检验以下前提，即在严重的受试者的急性康复中添加练习 手臂障碍是一种新型的康复工具，可促进恢复的神经塑性机制 增强这些受试者的临床结果。关于慢性中风主题的初步数据为支持 这项研究的中心前提。我们发现患有慢性中风的人接受18次会议 使用Myopro展览改善术的临床结果的个性化实践。在这个 拟议的研究，为了测试我在急性康复阶段的前提，十名急性缺血性中风的受试者（2 - 中风后14天）将使用A-Myopro获得18个个性化练习。改进 将通过临床测量测量的上肢障碍和功能将 报告了标准护理结果。神经生理和神经影像学工具将用于收集信息 在研究期间的神经塑性变化。该CDA-1将告知是否实施A- 急性康复中的Myopro是可行的，并导致研究人群的手臂功能改善。 在过渡到临床神经康复领域期间，这个项目对我来说是理想的选择。具体来说，与 我的主要心理和全面心理团队的帮助，我将开始接受（1）临床结果的培训 中风主体的措施，（2）神经康复研究中的神经生理和神经影像学工具，（3） 临床最佳实践和临床试验管理的准备以及（4）方面成为一个 独立的临床研究人员。我的项目与成为领先的职业目标高度融合 VA医疗中心内临床神经康复的研究者。