CAREER: Maintaining volitional effort during electrical stimulation-assisted stroke rehabilitation

职业：在电刺激辅助中风康复期间保持意志力

• 批准号: 1942402
• 负责人: Michael Fu
• 金额: $ 55万
• 依托单位: Case Western Reserve University
• 依托单位国家: 美国
• 项目类别: Continuing Grant
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1942402&HistoricalAwards=false
• 关键词: CAREER; Maintaining; volitional; effort; during

Limb paresis (muscular weakness due to nerve damage or disease) affects millions of Americans with neurological injuries such as stroke and cerebral palsy. Functional electrical stimulation (FES) is widely used to assist weakened limb movement so that people with neurological injury can better participate in therapy. Though it has never been proven, FES is thought to promote motor skill relearning because it synchronizes a person’s intent to move with limb movement. If this is not the case, there is a risk that participants can”slack” by reducing effort and allowing FES to passively move the weakened limb, which does not benefit motor skill relearning. This CAREER project addresses this issue by developing techniques to measure and prevent slacking during FES assisted therapy, which could have broad clinical impact as FES is widely used in rehabilitation medicine. The project's educational goal is to use video game production as a platform to develop opportunities for K-12 and college students to actively participate in rehabilitation science and engineering. Rehabilitation video game development will be integrated into ongoing science education programs for primary school, high school, and college students. A “Games for FUNction” program will train college and high school students to create video games for clinician clients and an “E-stim for Educators” lab will train primary school teachers to introduce rehabilitation engineering to their students.The principal investigator’s long-term mission is to deploy home-based virtual environment therapies that restore lost function for people with brain injury. Towards this mission, this CAREER project will create an effort-dependent FES assistance modality and demonstrate its ability to maintain participant effort during task-based and video game-based stroke rehabilitation. Studies are designed to answer the following questions: How accurately can effort be estimated during FES? Does FES assistance cause participants to slack during task practice? Can an effort-dependent FES control algorithm maintain participant effort during hand therapy video games? The project builds on preliminary results showing that, during time-varying (dropped pulses) FES stimulation, methods can be developed to extract volitional EMG (electromyography) signals, which can be used to estimate participant effort, from EMG signals that also contain the much greater in amplitude signal evoked by the stimulation. The Research Plan is organized under three Aims. The FIRST Aim is to determine how accurately volitional EMG can be estimated during time-varying FES using existing methods. Using data obtained from adults with chronic post-stroke hemiplegia with hand opening impairment, studies are designed to reveal how well existing signal processing techniques can eliminate FES interference and estimate participant effort during volitional finger extension efforts. The SECOND Aim is to characterize the effect of FES assistance on finger extension efforts when practicing tasks with FES-assisted hand opening to determine if FES assistance causes participants to slack during finger extension efforts and to shed light on the unknown relationship between FES and effort. Computational EMG occlusion models will be used to create person-specific calibrations to prevent effort underestimation. The THIRD Aim is to design an FES assistance modality that maintains continuous effort during task practice. The design includes an effort-dependent control framework that translates the degree of non-paretic hand opening directly into the stimulation pulse width applied to the paretic hand by way of a recruitment curve. This contralaterally-controlled FES modality (CCFES) will be used to investigate whether slacking can be prevented during FES assisted finger extension when FES assistance is applied in direct proportion to volitional effort and hand opening error, with the expectation that effort dependent FES will increase participant effort compared to effort independent FES. Though this project focuses on motor function recovery following stroke, FES is widely used in rehabilitation medicine, thus the proposed effort-dependent FES modality is also expected to lead to more effective delivery therapy for people with cerebral palsy, spinal cord injury, traumatic brain injury, sports injury, and pain.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

肢体轻瘫（由于神经损伤或疾病引起的肌肉无力）影响着数百万患有中风和脑瘫等神经损伤的美国人。功能电刺激（FES）被广泛应用于辅助肢体运动，使神经损伤患者能够更好地参与治疗。虽然它从未得到证实，但FES被认为可以促进运动技能的重新学习，因为它使一个人的运动意图与肢体运动同步。如果不是这种情况，参与者可能会因为减少努力而“懈怠”，并允许FES被动地移动虚弱的肢体，这不利于运动技能的重新学习。这个CAREER项目通过开发技术来测量和防止FES辅助治疗过程中的松弛，解决了这个问题，这可能会产生广泛的临床影响，因为FES广泛应用于康复医学。该项目的教育目标是利用视频游戏制作作为平台，为K-12和大学生提供积极参与康复科学和工程的机会。康复视频游戏开发将被整合到小学、高中和大学生的科学教育项目中。“功能游戏”项目将培训大学和高中学生为临床医生制作视频游戏，“教育工作者E-stim”实验室将培训小学教师向学生介绍康复工程。首席研究员的长期任务是部署基于家庭的虚拟环境疗法，为脑损伤患者恢复失去的功能。为了实现这一目标，该CAREER项目将创建一种依赖于努力的FES援助模式，并展示其在基于任务和基于视频游戏的中风康复期间保持参与者努力的能力。研究的目的是回答以下问题：在FES期间，对工作量的估计有多准确？FES协助是否会导致参与者在任务练习中懈怠？努力依赖的FES控制算法能否在手部治疗视频游戏中保持参与者的努力？该项目建立在初步结果的基础上，该结果表明，在时变（脉冲下降）FES刺激期间，可以开发方法从肌电图信号中提取意志肌电图（肌电图）信号，该信号可用于估计参与者的努力程度，肌电图信号也包含刺激引起的幅度更大的信号。研究计划有三个目标。第一个目标是确定使用现有方法在时变FES期间估计意志肌电信号的准确性。使用从患有慢性卒中后偏瘫并手张开障碍的成年人中获得的数据，研究旨在揭示现有的信号处理技术在消除FES干扰和估计参与者在自愿手指伸展努力过程中的努力程度方面的效果。第二个目的是描述FES辅助手张开练习任务时，FES辅助对手指伸伸努力的影响，以确定FES辅助是否会导致参与者在手指伸伸努力时懈怠，并阐明FES与努力之间未知的关系。计算肌电图闭塞模型将用于创建个人特定的校准，以防止努力低估。第三个目标是设计一种在任务练习中保持持续努力的FES辅助模式。该设计包括一个依赖于努力的控制框架，该框架将非麻痹手张开的程度直接转化为通过吸收曲线施加到麻痹手的刺激脉冲宽度。这种对侧控制的FES模式（CCFES）将用于研究当FES辅助与意志努力和手张开误差成正比时，是否可以防止FES辅助手指伸指过程中的松弛，期望与不依赖努力的FES相比，依赖努力的FES会增加参与者的努力。虽然本项目侧重于脑卒中后运动功能的恢复，但FES在康复医学中应用广泛，因此所提出的努力依赖FES模式也有望为脑瘫、脊髓损伤、创伤性脑损伤、运动损伤和疼痛患者带来更有效的递送治疗。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

项目成果

Distally-referred surface electrical nerve stimulation (DR-SENS) for haptic feedback

用于触觉反馈的远端表面电神经刺激 (DR-SENS)

• DOI: 10.1088/1741-2552/ad0563
• 发表时间: 2023
• 期刊: Journal of Neural Engineering
• 影响因子: 4
• 作者: Mesias, Luis;Gormez, M. Akif;Tyler, Dustin J.;Makowski, Nathaniel S.;Graczyk, Emily L.;Fu, Michael J.
• 通讯作者: Fu, Michael J.

A Low-Cost Bioimpedance Phase Angle Monitor for Portable Electrical Surface Stimulation Burn Prevention

• DOI: 10.1109/tcsii.2020.3029372
• 发表时间: 2021-04-01
• 期刊: IEEE TRANSACTIONS ON CIRCUITS AND SYSTEMS II-EXPRESS BRIEFS
• 影响因子: 4.4
• 作者: Burns, Ryan P.;Dunning, Jeremy;Fu, Michael J.
• 通讯作者: Fu, Michael J.