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.

项目概要 仅在美国就有超过 700 万中风幸存者，每年新增病例约 795,000 例。 尽管采用最好的物理疗法，但 30-60% 的中风幸存者仍然受到步态功能障碍的影响，其中 鉴于中风后步态障碍仍未得到最佳解决，足下垂往往是主要原因。 需要能够提供持久的神经和功能改善的新方法。 脑机接口（BCI）技术可能就是这样一种新颖的方法。 通过翻译大脑电生理学，对辅助设备和假肢等外部设备进行“大脑控制” 当 BCI 系统与功能性电刺激集成时，将信号（例如 EEG）转换为控制信号。 (FES) 系统，它们可用于提供一种新型物理疗法，以改善中风后的运动功能。 FES 系统竞相刺激赫布可塑性过程（其中“神经元一起放电，连接 在一起”），这种方法可能会导致中风后的功能恢复超出传统的物理疗法。 apy.申请人的初步研究表明，将该技术应用于中风后足下垂是安全的。 并可能通过神经过程改善步态功能，因此，这需要进一步研究： 1. 确定是否。 BCI-FES 疗法可以为患有足下垂的慢性中风患者提供步态功能的持久改善；2. 确定； 哪些因素影响 BCI-FES 治疗；3. 明确阐明潜在的神经修复机制。 首先，一项针对慢性中风导致足下垂患者的 II 期临床试验将比较 BCI 的效果 FES 背屈疗法与剂量和强度匹配的标准物理疗法（目标 1）。 两组之间步态速度和其他次要结果指标的改善将测试 假设 BCI-FES 疗法提供的功能和神经学益处超出了传统的物理治疗 它还将确定 BCI-FES 疗法最能解决步态障碍的哪些方面。 与传统物理治疗相比，受试者的基线特征（步态速度、 背屈功能、运动诱发电位、脑电图特征、感觉），结果将 确定哪些特征会影响 BCI-FES 背屈疗法的反应（目标 2）。 将使用显式计算来阐明驱动 BCI-FES 神经系统改善的机制 中风恢复的神经科学模型，通过实验神经生理学测量得出信息（目标 3）。 确定 BCI-FES 疗法可以提供超越传统疗法的改善可能会导致 一种对中风患者有效的新神经修复机制可以为设计提供信息。 最后，BCI-FES 疗法可能最终成为一种技术。 新型物理疗法可减少中风后残疾，进而减轻中风的公共卫生负担。