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.

肢体麻痹（由于神经损伤或疾病导致的肌肉无力）影响着数百万患有中风和脑瘫等神经损伤的美国人。功能性电刺激（FES）广泛用于辅助无力的肢体运动，使神经损伤患者能够更好地参与治疗。尽管从未得到证实，但 FES 被认为可以促进运动技能的重新学习，因为它可以使人的移动意图与肢体运动同步。如果情况并非如此，则存在参与者可能通过减少努力并允许 FES 被动移动虚弱肢体而“懈怠”的风险，这不利于运动技能的重新学习。该职业项目通过开发在 FES 辅助治疗期间测量和防止松弛的技术来解决这个问题，由于 FES 广泛应用于康复医学，这可能会产生广泛的临床影响。该项目的教育目标是利用视频游戏制作作为平台，为K-12和大学生积极参与康复科学与工程创造机会。康复视频游戏的开发将被纳入针对小学、高中和大学生的持续科学教育计划中。 “Games for FUNction”计划将培训大学生和高中生为临床医生客户制作视频游戏，“E-stim for Educators”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家庭虚拟环境疗法，帮助脑损伤患者恢复失去的功能。 为了实现这一使命，这个 CAREER 项目将创建一种依赖于努力的 FES 辅助模式，并展示其在基于任务和基于视频游戏的中风康复过程中保持参与者努力的能力。研究旨在回答以下问题：FES 期间的努力估算有多准确？ FES 协助是否会导致参与者在任务练习期间懈怠？依赖于努力的 FES 控制算法能否在手部治疗视频游戏期间保持参与者的努力？该项目建立在初步结果的基础上，该结果表明，在时变（下降脉冲）FES 刺激期间，可以开发方法从 EMG 信号中提取意志 EMG（肌电图）信号，该信号可用于估计参与者的努力，EMG 信号还包含由刺激引起的幅度更大的信号。 该研究计划根据三个目标进行组织。 第一个目标是确定使用现有方法在时变 FES 期间估计意志肌电图的准确度。 利用从患有慢性中风后偏瘫且手部张开障碍的成年人获得的数据，研究旨在揭示现有信号处理技术如何消除 FES 干扰并估计参与者在有意识的手指伸展努力期间的努力程度。 第二个目标是在使用 FES 辅助的张手练习任务时表征 FES 辅助对手指伸展努力的影响，以确定 FES 辅助是否会导致参与者在手指伸展努力期间松弛，并揭示 FES 与努力之间的未知关系。 计算肌电图遮挡模型将用于创建针对个人的校准，以防止低估努力。 第三个目标是设计一种 FES 辅助方式，在任务练习期间保持持续的努力。 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换为通过募集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，在 FES 辅助手指伸展期间是否可以防止松弛，并期望与努力无关的 FES 相比，努力依赖的 FES 将增加参与者的努力。虽然该项目侧重于中风后的运动功能恢复，但 FES 广泛应用于康复医学，因此所提出的依赖努力的 FES 模式也有望为脑瘫、脊髓损伤、脑外伤、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 NSF 的法定使命，并通过使用基金会的智力价值和更广泛的影响审查进行评估，被认为值得支持 标准。

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.