Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton.
Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton.
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DOI：
10.3389/fnins.2016.00284
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发表时间：
2016
影响因子：
4.3
通讯作者：
Gharabaghi A
中科院分区：
文献类型：
--
作者：
Grimm F;Gharabaghi A
严重运动障碍的脑卒中患者不能用其患侧上肢进行任务型康复训练。先进的康复技术可以支持他们进行这种伸手抓的运动。然而，挑战在于提供必要的援助，同时保持参与者在演习期间的承诺。在这项可行性研究中，我们引入了一种闭环神经假体，用于伸手抓握辅助，它将自适应多通道神经肌肉刺激与多关节手臂外骨骼相结合。18名严重受影响的慢性中风患者得到重力补偿的七自由度外骨骼的帮助，该外骨骼连接到麻痹手臂上，用于在虚拟环境中进行类似日常生活活动的伸手抓握练习。在练习过程中，自适应电刺激被施加到七个不同的肌肉的上肢在性能依赖的方式，以提高任务为导向的运动轨迹。刺激强度针对每个目标肌肉进行个性化，并保持亚阈值，即，没有得到公开的支持。闭环神经肌肉刺激可以很好地整合到基于外骨骼肌的训练中，并增加了任务相关的运动范围（p = 0.0004）和运动速度（p = 0.015），同时保持准确性。需要最高的相对刺激强度来促进抓握功能。易化活动度与患者的上肢Fugl-Meyer评估评分相关（p = 0.028）。将自适应多通道神经肌肉刺激与反重力辅助相结合，可以在康复锻炼期间增强严重影响的中风患者的残余运动能力，从而可以为患者量身定制的支持提供定制的训练环境，同时保持参与者的参与度。
Stroke patients with severe motor deficits cannot execute task-oriented rehabilitation exercises with their affected upper extremity. Advanced rehabilitation technology may support them in performing such reach-to-grasp movements. The challenge is, however, to provide assistance as needed, while maintaining the participants' commitment during the exercises. In this feasibility study, we introduced a closed-loop neuroprosthesis for reach-to-grasp assistance which combines adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Eighteen severely affected chronic stroke patients were assisted by a gravity-compensating, seven-degree-of-freedom exoskeleton which was attached to the paretic arm for performing reach-to-grasp exercises resembling activities of daily living in a virtual environment. During the exercises, adaptive electrical stimulation was applied to seven different muscles of the upper extremity in a performance-dependent way to enhance the task-oriented movement trajectory. The stimulation intensity was individualized for each targeted muscle and remained subthreshold, i.e., induced no overt support. Closed-loop neuromuscular stimulation could be well integrated into the exoskeleton-based training, and increased the task-related range of motion (p = 0.0004) and movement velocity (p = 0.015), while preserving accuracy. The highest relative stimulation intensity was required to facilitate the grasping function. The facilitated range of motion correlated with the upper extremity Fugl-Meyer Assessment score of the patients (p = 0.028). Combining adaptive multi-channel neuromuscular stimulation with antigravity assistance amplifies the residual motor capabilities of severely affected stroke patients during rehabilitation exercises and may thus provide a customized training environment for patient-tailored support while preserving the participants' engagement.