Evaluation of robot assisted neuro-rehabilitation

机器人辅助神经康复的评价

基本信息

批准号：
7749890
负责人：
CHRISTOPHER T BEVER
金额：
--
依托单位：
BALTIMORE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2012-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7749890
关键词：
Activities of Daily Living Acute Adherence Adopted Adult Affect Age Area Behavior Therapy Behavioral Brain Brain Diseases Caring Chronic Clinical Clinical Data Data Development Devices Diagnosis Disease Distal Elbow Elements Enrollment Evaluation Exercise Foundations Functional disorder General Population Goals Grant Guidelines Hand Health Health Insurance Healthcare Systems Home Nursing Care Home environment Impairment Incidence Individual Inpatients Intervention Joint structure of shoulder region Lead Lesion Life Limb structure Literature Longevity Maps Measurement Measures Methods Mission Modeling Motor Motor Activity Motor Cortex Movement Multiple Sclerosis Muscle Nervous system structure Neurologic Neurological rehabilitation Neurorehabilitation Occupational Therapy Outcome Outcome Measure Parkinsonian Disorders Patients Performance Persons Phase Physical Restraint Physiology Pilot Projects Play Population Positron-Emission Tomography Procedures Publishing Quality of life Randomized Randomized Controlled Trials Recovery Recovery of Function Recurrence Rehabilitation therapy Research Resources Robot Robotics Role Screening procedure Shoulder Side Single-Blind Study Specificity Stroke Surrogate Markers Survivors System Testing Therapeutic Therapeutic Intervention Time Training Training Programs Transcranial magnetic stimulation Translations Traumatic Brain Injury Treatment Protocols Unemployment United States Upper Extremity Upper arm Veterans Work Wrist arm base care delivery care seeking chronic stroke constraint induced therapy cost diaries disability effective therapy follow-up functional improvement grasp hemiparesis hemiparetic stroke hospital readmission improved improved functioning kinematics loss of function motor impairment neuromechanism performance tests post stroke public health relevance rehabilitation service response robot assistance skills standard of care stroke recovery theories treatment strategy trial comparing

项目摘要

DESCRIPTION (provided by applicant): Upper extremity dysfunction is an important part of the disability caused by stroke, the leading cause of long term disability in adults. An evolving body of research suggests that specific rehabilitation interventions can improve functioning in an impaired arm even after sustained loss of function. We and others have shown that robot assisted rehabilitation can reduce arm impairment compared to baseline. We have now shown that robot assisted rehabilitation can reduce arm impairment in a randomized, single-blind trial compared to conventional occupational therapy. Studies of robotic training and also constraint-induced therapy suggest that specific training on functional tasks may enhance to translation of training gains into improved function. We propose to study the value of adding a functional training session (which we refer to as transition to task training or TTT) to robotic training. One published study suggests that robotic training induces changes in cortical motor maps. We will conduct studies of cortical motor excitability in our patients before and after training to investigate this issue. Criteria for determining the maximum benefit of robotic training have not yet been developed. One approach would be to conduct conventional upper extremity evaluations during the course of therapy but that would significantly increase therapist time. The robots record the assistance provided to patients during each training session and we will examine whether that data might be used on an ongoing basis to evaluate patient benefit. Primary hypothesis: TTT immediately following each robotic training session leads to greater functional improvement than robot- assisted training alone for patients with chronic upper extremity dysfunction due to hemi-paretic stroke. Secondary mechanistic hypothesis: Robotic training results in alterations in cortical motor excitability as detected by transcranial magnetic stimulation. Secondary clinical hypothesis: Robot kinematic data will reflect the functional changes seen in the training and that this information can be used clinically to determine when a patient has reached maximum benefit from robotic training. In order to test these hypotheses we propose a randomized, single-blind trial comparing 36-60 minute robotic training sessions with 36 training session consisting of 45 minutes of robotic training and 15 minutes of TTT training. Outcomes will include upper arm functional assessments, the results of transcranial magnetic stimulation and robot generated kinematic data. Page 1 PUBLIC HEALTH RELEVANCE: Relevance to the VHA Care Mission Stroke is the leading cause of permanent disability in the United States with 780,000 strokes occurring each year (1). Improvement in the management of its care is one area targeted by the VA. Stroke can lead to permanent, sometimes progressive, neurological impairment with upper extremity involvement often seen in more severely impaired patients. The majority of veterans with stroke each year receive inpatient rehabilitation. Yet many of individuals remain severely limited in their participation in life tasks because of decreased functional use of the affected upper extremity (33). The problem of upper extremity dysfunction due to stroke has a disproportionate effect on the VHA health care system; the chronicity and disability frequently causes patients to become unemployed, loose their health insurance and to deplete their own resources so that they are forced to seek care through the VHA system. In addition, the incidence of stroke increases with age and the VHA enrolled population is older than the general population. Approximately 75,000 stroke survivors are cared for by the VHA system and more than half of those patients have significant loss of upper extremity function. While the VHA enrolled population is actually decreasing (as WWII vets expire), the demand for rehabilitation services is expected to in the coming decades due to increased longevity. Upper extremity neuro-rehabilitation has the potential for improving the VA systems delivery of care in several ways. The delivery of more efficient and effective therapy for upper extremity use and carry-over to the home environment has the potential to reduce long-term costs of care (need for nursing home care, and hospital readmissions). If robot training combined with transition to task training is found to be significantly more effective in improving function, then adopting this combination will improve the standard of care. Robotic therapy also provides new, objective measures to assist in diagnosis of movement deficits, evaluate progress, and customize therapy through robot adaptation and control (42). Finally, perhaps even more important, stroke can be a model for other brain disorders that are more difficult to study. Traumatic brain injury, multiple sclerosis, and Parkinsonism have prominent motor impairments that result from brain lesions. There is a possibility that further understanding of the neural mechanisms of therapy-related to recovery of stroke may be applicable to these other disorders (42). Particularly for individuals with traumatic brain injury, which may affect younger veterans, expanding the range and specificity of rehabilitation therapies will have a positive impact on veterans' health and quality of life over the course of a lifetime. Page 1

描述（由申请人提供）：上肢功能障碍是中风引起的残疾的重要组成部分，这是成人长期残疾的主要原因。不断发展的研究表明，即使在持续的功能丧失后，特定的康复干预措施也可以改善手臂受损的功能。我们和其他人表明，与基线相比，机器人辅助康复可以减少手臂损伤。我们现在已经表明，与常规职业治疗相比，机器人辅助康复可以减少随机的单盲试验中的手臂障碍。机器人训练以及约束诱导的治疗的研究表明，对功能任务的特定培训可能会增强训练增益转化为改善功能的转化。我们建议研究添加功能培训课程（我们称为任务培训或TTT的过渡）的价值。一项已发表的研究表明，机器人训练会引起皮质运动图的变化。我们将在培训前后对患者进行皮质运动兴奋性的研究，以调查此问题。确定机器人训练的最大收益的标准尚未开发出来。一种方法是在治疗过程中进行常规的上肢评估，但这将大大增加治疗师的时间。机器人在每个培训期间记录了为患者提供的援助，我们将检查是否可以持续使用该数据来评估患者的福利。主要假设：在每次机器人训练课程之后，TTT立即与仅机器人辅助训练相比，仅针对由于半肢体中风而导致的慢性上肢功能障碍的患者，其功能性改善。次级机械假设：机器人训练会导致经颅磁刺激检测到的皮质运动兴奋性的改变。次要临床假设：机器人运动学数据将反映训练中看到的功能变化，并且可以在临床上使用该信息来确定何时患者从机器人训练中获得最大收益。为了检验这些假设，我们提出了一项随机的单盲试验，将36-60分钟的机器人训练课程与36个训练课程进行了比较，包括45分钟的机器人训练和15分钟的TTT培训。结果将包括上臂功能评估，经颅磁刺激的结果和机器人产生的运动学数据。第1页公共卫生相关性：与VHA护理任务中风相关的是美国永久残疾的主要原因，每年发生78万中风（1）。改善其护理的管理是VA针对的领域。中风会导致永久性的，有时是渐进的神经系统障碍，并且在更严重受损的患者中经常看到上肢介入。每年大多数中风的退伍军人接受住院康复。然而，由于受影响的上肢的功能使用降低，许多人的参与人生任务的参与受到严重限制（33）。上肢功能障碍因中风引起的问题对VHA医疗保健系统的影响不成比例。慢性和残疾经常导致患者失业，放松健康保险并耗尽自己的资源，以便他们被迫通过VHA系统寻求护理。此外，中风的发生率随着年龄的增长而增加，而VHA的人口比一般人群更古老。 VHA系统为大约75,000名中风幸存者提供了照顾，其中一半以上的患者在上肢功能上丧失。尽管VHA招收的人口实际上正在减少（因为第二次世界大战的兽医到期），但由于寿命的增加，对康复服务的需求预计将在未来几十年中。上肢神经措施有可能通过多种方式改善VA系统的提供。提供更有效的上肢使用和携带到家庭环境的更有效的疗法有可能降低长期护理成本（需要疗养院护理和医院再入院）。如果发现机器人训练与过渡到任务培训相结合在改善功能方面的有效性更大，那么采用这种组合将改善护理标准。机器人疗法还提供了新的客观措施，以帮助诊断运动缺陷，评估进度并通过机器人适应和控制来定制治疗（42）。最后，也许更重要的是，中风可以成为其他更难研究的脑疾病的模型。脑损伤，多发性硬化症和帕金森氏症具有脑部病变引起的显着运动障碍。有可能进一步了解与中风相关的治疗相关的神经机制可能适用于这些其他疾病（42）。特别是对于可能影响年轻退伍军人的脑损伤的人，扩大康复疗法的范围和特异性将对退伍军人的健康和生活质量产生积极影响。第1页