Brain-computer interface-functional electrical stimulation for stroke recovery

脑机接口-功能性电刺激促进中风康复

• 批准号: 10614001
• 负责人: Steven C. Cramer
• 金额: $ 70.39万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614001
• 关键词: Address; Affect; Automobile Driving; Behavioral; Brain; Caring; Characteristics; Clinical; Devices; Dose; Electric Stimulation Therapy; Electroencephalography; Electrophysiology (science); Esthesia; Fire - disasters; Foot-drop; Future; Gait; Health Care Costs; Healthcare; Impairment; Individual; Injury; Investigation; Link; Measurement; Methods; Modeling; Motor; Motor Cortex; Motor Evoked Potentials; Motor Neurons; Movement; Muscle; Neurobiology; Neurologic; Neurons; Outcome; Outcome Measure; Patients; Phase II Clinical Trials; Phase III Clinical Trials; Physical therapy; Physiological; Process; Productivity; Prosthesis; Public Health; Quality of life; Recovery of Function; Regimen; Rehabilitation therapy; Research; Self-Help Devices; Signal Transduction; Spinal cord injury; Stroke; Subgroup; System; Techniques; Technology; Testing; Time; Translating; Upper Extremity; Walking; Work; acute stroke; aging population; brain computer interface; brain shape; caregiving; chronic stroke; computational neuroscience; conventional therapy; cost; design; disability; functional electrical stimulation; functional improvement; improved; medical complication; mind control; motor function improvement; neural; neural repair; neurological rehabilitation; neurophysiology; novel; novel strategies; novel therapeutics; post stroke; primary outcome; secondary outcome; social; stroke model; stroke patient; stroke recovery; stroke rehabilitation; stroke survivor; stroke therapy; tibialis anterior muscle; tool

Project Summary There are over 7 million stroke survivors in the US alone, with approximately 795,000 new cases annually. Despite the best available physiotherapy, 30-60% of stroke survivors remain affected by gait function impairments, with foot drop often being the primary cause. Given that post-stroke gait impairments remain suboptimally addressed, novel methods that can provide lasting neurological and functional improvements are necessary. Brain-computer interface (BCI) technology may be one such novel approach. BCI technology enables “direct brain control” of external devices such as assistive devices and prostheses by translating brain electrophysiologi- cal signals (e.g. EEG) into control signals. When BCI systems are integrated with functional electrical stimulation (FES) systems, they can be used to deliver a novel physiotherapy to improve motor function after stroke. BCI- FES systems are hypothesized to stimulate a Hebbian plasticity process (where “neurons that fire together, wire together”), and this approach may lead to functional recovery after stroke beyond that of conventional physiother- apy. The applicant's preliminary research indicates that applying this technique to foot drop after stroke is safe and may improve gait function via neural processes. Hence, this warrants further investigation to: 1. determine if BCI-FES therapy can provide lasting gains in gait function in chronic stroke patients with foot drop; 2. determine what factors influence BCI-FES therapy; and 3. explicitly elucidate the underlying neural repair mechanisms. First, a Phase II clinical trial in patients with foot drop due to chronic stroke will compare the effect of BCI- FES dorsiflexion therapy to that of dose- and intensity-matched standard physiotherapy (Aim 1). Comparing the improvement in gait velocity and other secondary outcome measures between the two groups will test the hypothesis that BCI-FES therapy provides functional and neurological gains beyond those of conventional phys- iotherapy. It will also determine which aspects of gait impairment are best addressed with BCI-FES therapy versus conventional physiotherapy. The relationship between the subjects' baseline characteristics (gait velocity, dorsiflexion function, motor evoked potentials, electroencephalogram features, sensation) and the outcomes will determine what features influence responsiveness to BCI-FES dorsiflexion therapy (Aim 2). Finally, the underlying mechanism driving the neurological improvements of BCI-FES will be elucidated using an explicit computational neuroscience model of stroke recovery, informed by experimental neurophysiological measurements (Aim 3). Determining that BCI-FES therapy can provide improvements beyond that of conventional therapy may lead to a new neural repair mechanism that can be effective in stroke patients. This mechanism can inform the design of future physiotherapy techniques or improve current ones. Finally, BCI-FES therapy may ultimately become a novel form of physiotherapy to reduce post-stroke disability, and in turn reduce the public health burden of stroke.

项目摘要 仅美国就有超过700万个中风存活率，每年约有795,000个新案件。尽管 最好的理疗最佳物理疗法，30-60％的中风存活仍然受步态功能障碍的影响， 脚下通常是主要原因。鉴于中风后AIT障碍仍然在次优的解决中， 需要提供持久的神经系统和功能改进的新方法。 脑部计算机界面（BCI）技术可能就是一种新颖的方法。 BCI技术可以直接 大脑控制”外部设备（例如辅助设备和假体）通过翻译大脑电生理学 - CAL信号（例如脑电图）进入控制信号。当BCI系统与功能电气模拟集成时 （FES）系统，它们可用于提供新颖的物理疗法，以改善中风后运动功能。 bci- 假设FES系统以刺激HEBBIAN可塑性过程（“融合在一起的神经元，导线 ”），这种方法可能导致中风后的功能恢复 APY。申请人的初步研究表明，将此技术应用于中风后的脚部下降是安全的 并可以通过神经过程提高步态功能。因此，这需要进一步调查：1。确定是否是否 BCI-FES疗法可以在慢性中风患者的慢性中风患者中提供持久的收集功能； 2。确定 哪些因素影响BCI-FES治疗；和3。明确阐明了基本的神经修复机制。 首先，一项II期临床试验对由于慢性中风引起的脚部下降患者的临床试验将比较BCI-的影响 对剂量和强度匹配的标准物理疗法的反to骨治疗（AIM 1）。比较 两组之间的搅拌速度和其他次级结果度量的改善将测试 BCI-FES疗法的假设可提供功能性和神经系统收益 病毒疗法。它还将确定最好通过BCI-FES治疗解决AIT损伤的哪些方面 与常规的物理疗法相比。受试者的基线特征（步态速度， 背部浮游功能，诱发电势，脑电图特征，感觉）和结果将 确定哪些特征对BCI-FES背膜疗法的影响（AIM 2）。最后，基础 驱动BCI-FES神经系统改善的机制将使用明确的计算来阐明 通过实验性神经生理测量结果，中风恢复的神经科学模型（AIM 3）。 确定BCI-FES疗法可以提供超出常规治疗的改进 可以在中风患者中有效的新神经修复机制。这种机制可以告知设计 未来的理疗技术或改善当前的技术。最后，BCI-FES疗法最终可能成为 新型的物理疗法形式可减少势后残疾，进而减少中风的公共卫生烧伤。