A neuroprosthesis for tremor management through the control of muscle co-contraction.
A neuroprosthesis for tremor management through the control of muscle co-contraction.
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通过控制肌肉共同收缩的神经假体用于震颤管理。
DOI：
10.1186/1743-0003-10-36
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发表时间：
2013-04-15
影响因子：
5.1
通讯作者：
Pons JL
中科院分区：
文献类型：
--
作者：
Gallego JÁ;Rocon E;Belda-Lois JM;Pons JL
病理性震颤是最常见的运动障碍。目前的治疗在大部分患者中没有达到显著的震颤减少，这使得震颤成为生活质量损失的主要原因。例如，根据一些估计，65%的上肢震颤患者报告日常生活有严重困难。因此，需要用于震颤管理的新形式。由于肌肉本质上表现为低通滤波器，并且震颤频率高于意志运动的频率，因此作者设想利用这些特性作为开发新型治疗替代方案的手段。这种治疗将依赖于肌肉共同收缩来控制震颤，类似于完整的中枢神经系统在某些任务期间稳定肢体所采用的策略。我们实施了一种神经假体，通过经皮神经刺激在一对拮抗剂处注入电流来调节肌肉共同收缩的水平。共收缩适应震颤的瞬时参数，这是从一对固态陀螺仪的原始记录与特意设计的自适应算法估计。对于实验验证，我们招募了6名患有不同严重程度的帕金森病或特发性震颤的患者，并在用于神经系统检查的标准任务期间评估了神经假体的效果。神经假体对震颤有明显的衰减作用（p<0.001），振幅降低52.33± 25.48%。此外，它减轻了原发性和帕金森震颤，尽管他们的不同病因和病理学。震颤严重程度不是神经假体性能的限制因素，尽管存在更严重震颤衰减更大的微妙趋势。震颤频率在神经刺激期间没有改变，正如帕金森病和原发性震颤的中枢起源所预期的那样。所有患者在舒适性和无疼痛方面对神经刺激表现出良好的耐受性，一些患者自发报告说，当神经假体激活时，他们感觉震颤减少。本文所呈现的结果表明，神经假体提供了两种主要类型的震颤的系统衰减，而不管其严重程度如何。这项研究为神经假体作为震颤管理的替代非侵入性手段的验证奠定了基础。
Pathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering from upper limb tremor report serious difficulties during daily living. Therefore, novel forms for tremor management are required. Since muscles intrinsically behave as a low pass filter, and tremor frequency is above that of volitional movements, the authors envisioned the exploitation of these properties as a means of developing a novel treatment alternative. This treatment would rely on muscle co-contraction for tremor management, similarly to the strategy employed by the intact central nervous system to stabilize a limb during certain tasks. We implemented a neuroprosthesis that regulated the level of muscle co-contraction by injecting current at a pair of antagonists through transcutaneous neurostimulation. Co-contraction was adapted to the instantaneous parameters of tremor, which were estimated from the raw recordings of a pair of solid state gyroscopes with a purposely designed adaptive algorithm. For the experimental validation, we enrolled six patients suffering from parkinsonian or essential tremor of different severity, and evaluated the effect of the neuroprosthesis during standard tasks employed for neurological examination. The neuroprosthesis attained significant attenuation of tremor (p<0.001), and reduced its amplitude up to a 52.33±25.48%. Furthermore, it alleviated both essential and parkinsonian tremor in spite of their different etiology and symptomatology. Tremor severity was not a limiting factor on the performance of the neuroprosthesis, although there was a subtle trend towards larger attenuation of more severe tremors. Tremor frequency was not altered during neurostimulation, as expected from the central origin of Parkinson’s disease and essential tremor. All patients showed a good tolerance to neurostimulation in terms of comfort and absence of pain, and some spontaneously reported that they felt that tremor was reduced when the neuroprosthesis was activated. The results presented herein demonstrate that the neuroprosthesis provides systematic attenuation of the two major types of tremor, irrespectively from their severity. This study sets the basis for the validation of the neuroprosthesis as an alternative, non-invasive means for tremor management.
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影响因子：
9.9
作者：
ELBLE, RJ
通讯作者：
ELBLE, RJ
影响因子：
8.6
作者：
Benito-León, J;Bermejo-Pareja, F;Molina, JA
通讯作者：
Molina, JA
影响因子：
11
作者：
ELBLE, RJ;HIGGINS, C;MOODY, CJ
通讯作者：
MOODY, CJ
DOI：
10.3390/s100302129
发表时间：
2010
期刊：
Sensors (Basel, Switzerland)
影响因子：
--
作者：
Gallego JA;Rocon E;Roa JO;Moreno JC;Pons JL
通讯作者：
Pons JL
影响因子：
64.8
作者：
Burdet, E;Osu, R;Kawato, M
通讯作者：
Kawato, M