Promoting paretic limb use in stroke survivors using exoskeleton and virtual reality technologies

使用外骨骼和虚拟现实技术促进中风幸存者使用偏瘫肢体

• 批准号: 10605387
• 负责人: Alexander Brunfeldt
• 金额: $ 6.95万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-07 至 2024-09-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10605387
• 关键词: 3D virtual reality; Activities of Daily Living; Acute; Adopted; American; Bilateral; Biological Assay; Biomedical Engineering; Cause of Death; Central Nervous System; Chronic Phase; Clinical; Collaborations; Couples; Coupling; Custom; Data; Electromyography; Engineering; Environment; Feedback; Force of Gravity; Future; Goals; Hand; Hemiplegia; Hospitals; Impairment; Individual; Institution; Knowledge; Learning; Limb structure; Manuals; Measures; Mentors; Mentorship; Monitor; Movement; Muscle; Neurology; Neurons; Output; Paresis; Participant; Patients; Pattern; Persons; Phenotype; Process; Publications; Recovery of Function; Regulation; Rehabilitation therapy; Reporting; Research; Research Personnel; Resistance; Stroke; Sum; Surface; System; Techniques; Technology; Testing; Therapeutic; Tissues; Training; Translating; United States; Universities; Upper Extremity; Visual; Weight; Work; acute stroke; arm; arm function; biceps brachii muscle; career; chronic stroke; control theory; deltoid muscle; design; disability; efficacious treatment; exoskeleton; experience; functional disability; hemiparesis; improved; individual patient; innovation; kinematics; motor control; neural; neuromuscular; next generation; novel; novel strategies; recruit; rehabilitation science; restoration; stroke patient; stroke rehabilitation; stroke survivor; virtual; virtual reality; virtual reality environment; virtual reality system

PROJECT SUMMARY Stroke is the 5th leading cause of death in the United States, and nearly 8 million Americans report it as their primary reason for disability. For many with hemiparesis caused by their stroke, existing rehabilitative therapies have failed to deliver sustained improvements in functional recovery. These therapies either focus on only the impaired limb or rely on training tasks with little resemblance to activities of daily living. Emerging research suggests that bilateral training may provide improvements beyond unilateral training alone, but the mechanisms underlying these benefits remain unknown. Therefore, the objective of this proposal is to determine the motor control and neuromuscular mechanisms responsible for bilateral coordinated reaching in stroke. To do this, we have developed a rehabilitation platform that uses virtual reality and exoskeleton technologies to provide the task and environmental constraints necessary to increase the use of the paretic limb in chronic stroke survivors. Our preliminary results in healthy controls and 4 stroke participants show that our system can change both the kinematic and neuromuscular control of upper extremity reaching. Our overarching hypothesis is that hemiplegic stroke participants respond these novel task and environmental constraints by adopting an optimal reaching strategy that manifests as systematic changes in impaired arm displacement and muscle activity. Specifically, in Aim 1 we will explore the tradeoff between arm displacement and muscle activity during a bimanual reaching task and in Aim 2, we will establish a neuromuscular mechanism of impaired limb recruitment during this task. Specifically, we use an advanced electromyographical technique to measure coactivation of homologous muscle pairs. Together, these two Aims will identify the kinematic and neuromuscular mechanisms responsible for functional changes in bilateral coordination in chronic stroke survivors. The proposed research is supported by a well-established mentorship team the spans clinical neurology, rehabilitation sciences, and biomedical engineering. The work will be carried out in a unique collaboration between Georgetown University, the MedStar National Rehabilitation Hospital, and The Catholic University of America. These institutions are perfectly integrated to provide the clinical, technical, and intellectual environment needed to complete the proposed work. Training will include mentored clinical experience with acute and chronic stroke survivors and train the applicant in advanced engineering approaches to stroke rehabilitation. Finally, the training plan is designed to transition the applicant into an independent research career focused on exploring the next generation of technological solutions to therapeutic challenges.

项目概要 中风是美国第五大死因，近 800 万美国人将其视为他们的疾病 残疾的主要原因。对于许多因中风导致偏瘫的人来说，现有的康复疗法 未能实现功能恢复的持续改善。这些疗法要么只关注 肢体受损或依赖与日常生活活动几乎没有相似之处的训练任务。新兴研究 表明双边培训可能比单独的单边培训有所改善，但其机制 这些好处的背后仍然未知。因此，本提案的目标是确定电机 负责中风双侧协调到达的控制和神经肌肉机制。为此，我们 开发了一个康复平台，利用虚拟现实和外骨骼技术来提供 增加慢性中风幸存者的瘫痪肢体的使用所必需的任务和环境限制。 我们在健康对照和 4 名中风参与者中的初步结果表明，我们的系统可以改变 上肢伸展的运动学和神经肌肉控制。我们的总体假设是偏瘫 中风参与者通过采取最佳到达方式来应对这些新任务和环境限制 表现为受损手臂位移和肌肉活动的系统性变化。具体来说，在 目标 1 我们将探索双手伸手过程中手臂位移和肌肉活动之间的权衡 在目标 2 中，我们将建立在此任务期间受损肢体募集的神经肌肉机制。 具体来说，我们使用先进的肌电图技术来测量同源肌肉的共激活 对。这两个目标共同将确定负责的运动学和神经肌肉机制 慢性中风幸存者双侧协调的功能变化。拟议的研究得到了支持 一个完善的导师团队，涵盖临床神经学、康复科学和生物医学 工程。这项工作将由乔治城大学、MedStar 之间的独特合作进行 国家康复医院和美国天主教大学。这些机构都完美 集成以提供完成拟议工作所需的临床、技术和智力环境。 培训将包括指导急性和慢性中风幸存者的临床经验并对申请人进行培训 中风康复的先进工程方法。最后，培训计划旨在过渡 申请人进入独立研究生涯，专注于探索下一代技术 治疗挑战的解决方案。