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.

据估计，每年有 15,000 名退伍军人遭受中风，其中超过 75% 的人患有持续性手部疾病 即使经过完整的康复过程，他们的独立性也会大大降低。 从根本上来说，中风后上肢损伤是由肌肉激活模式的改变引起的。于是，直接 肌肉激活模式的训练有希望。不幸的是，改变的肌肉激活模式并没有改变。 目前的康复治疗中已得到充分解决。以前的努力仅限于训练一对肌肉， 未能解决异常的段间耦合问题。为了解决这一差距，一种新颖的肌电图控制的游戏系统 已经开发出来：肌电图信号被映射到计算机屏幕上光标的二维运动 玩游戏。在一项初步研究中，目标 EMG 模式源自 4 个非麻痹性远端上肢 肢体肌肉肌电图，而比赛则使用 4 个麻痹远端上肢肌肉肌电图映射到 目标模式，从而促进在麻痹肢体中使用非麻痹肌肉激活模式。二十 通过 Wolf 运动功能测试功能能力评估，中风幸存者的上肢功能得到改善 (WMFT FA) 9 场比赛后显着。目的：扩大肌电图控制的能力 游戏系统并将其集成到完整的治疗范例中。目标一：完善制度。肌肉激活 模式将以非负肌电振幅为特征，使游戏控制更加直观。这 肌电图输入通道的数量将增加，以包括近端和远端上肢肌肉 段间培训。将创建更多游戏来提高参与度。改进系统的可行性 由神经系统完好的退伍军人进行评估。目标 2-3 将针对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到两组中的一组。治疗组将接受9 EMG 游戏课程和 9 个任务练习治疗课程交替进行。对照组将 接受 18 次任务练习治疗课程。评估将在基线、术后和 1 个月随访时进行。目的 2：确定肌电图游戏系统加任务练习疗法对上肢功能的影响。假设： 肌电图游戏的团体训练结合任务练习治疗将改善他们的上肢 WMFT FA（初级）评估的功能优于剂量匹配任务练习疗法的团体训练 仅有的。目标 3：确定与肌电图控制游戏训练相关的神经力学变化。 假设：仅在治疗时，麻痹肌肉激活模式才会同化非麻痹模式 团体。通过计算由麻痹肌电图定义的超平面之间的角度来量化相似性 模式和由非麻痹肌电图模式定义的平面。影响：这项研究将解决当前的问题 通过开发/评估新型肌电图控制游戏系统来训练肌肉激活模式来弥补治疗差距， 从而直接解决中风后运动障碍的根源。这项研究预计将提高上层 肢体康复结果，有助于提高中风退伍军人的独立性和生活质量。