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.

近 30 % 的中风幸存者最初有严重的手臂损伤，但手臂无法充分恢复 使他们能够独立进行日常生活活动的功能缺陷可以得到改善。 通过将康复与有前景的新技术相结合，利用肌电控制设备来利用弱者。 受影响的肌肉产生电信号，并将其放大以激活设备中的电机。 电机的运动增强了与该电机相关的关节中自己的意志运动。 该设备为用户提供移动瘫痪手臂所需的支撑 a-Myopro 是一款可调节的设备。 肌电控制矫形器，通过提供以下功能来促进瘫痪手和肘部的运动 通过四种运动模式提供帮助 a-Myopro 用户可以使用单一模式或多种模式进行训练。 可以组合模式以允许对单个或多关节运动进行更复杂的训练。 Myopro 为手臂功能受限的中风受试者提供独特的运动训练范例， 让他们能够有意识地练习孤立的手臂动作，否则他们无法自己练习。 在中风发作后的最初几周内，受伤的大脑经历了几种神经机制， 称为神经可塑性的过程，旨在重组神经连接并修复受损的神经 几项研究表明，在这个急性期进行康复可以改善受伤区域周围的组织。 大概通过调节尿液神经可塑性来增强瘫痪臂的功能结果 具体来说，有人提出了增强神经可塑性的新干预措施。 对于严重受损的中风幸存者来说，恢复机制尤其需要。 该 CDA1 提案的基本原理是探索肌电控制设备 a-Myopro 是否可以 该研究还将调查患有严重手臂缺陷的中风受试者的急性康复。 与标准护理相比，a-Myopro 的应用将更大程度地改善临床结果。 由于神经可塑性在急性期是呼吸性的，因此该研究旨在将神经生理学与神经可塑性相关联。 随着在该人群中练习 a-Myopro 所获得的增强而发生变化。 研究将测试以下前提：将 a-Myopro 练习添加到患有严重疾病的受试者的急性康复中 手臂损伤作为一种新型康复工具，可促进神经可塑性机制的恢复 增强这些受试者的临床结果为慢性中风受试者提供了支持。 这项研究的中心前提是，患有慢性中风的人接受了 18 次治疗。 使用 Myopro 进行的个性化实践显示出瘫痪臂临床结果的改善。 拟议的研究，为了在急性康复阶段检验我的假设，十名患有急性缺血性中风的受试者（2 – 中风后 14 天）将接受 18 次使用 a-Myopro 的个性化练习。 通过临床测量测量的上肢损伤和功能将与以前进行比较 报告的标准护理结果将用于收集信息。 该 CDA-1 将告知是否实施 a- Myopro 在急性康复中是可行的，并且可以改善研究人群的手臂功能。 这个项目对于我进入临床神经康复领域来说是理想的选择。 在我的主要导师和综合指导团队的帮助下，我将开始接受 (1) 临床结果的培训 中风受试者的措施，(2) 神经康复研究中的神经生理学和神经影像学工具，(3) 中风的临床最佳实践和临床试验管理的准备以及（4）成为一个方面 我的项目与我成为领先的职业目标高度结合。 退伍军人管理局医疗中心临床神经康复研究员。