Stroke Rehabilitation utilizing BCI technology

利用 BCI 技术进行中风康复

• 批准号: 10216364
• 负责人: Vivek Prabhakaran
• 金额: $ 44.63万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216364
• 关键词: Action Research; Address; Adopted; Affect; American; Animals; Anisotropy; Area; Base of the Brain; Behavior; Behavioral; Brain; Brain Injuries; Caregivers; Caring; Cause of Death; Clinical; Clinical Trials; Control Groups; Data; Dependence; Development; Devices; Diffuse; Diffusion Magnetic Resonance Imaging; Direct Costs; Educational workshop; Electric Stimulation; Electric Stimulation Therapy; Electrodes; Electroencephalogram; Equipment; Facilities and Administrative Costs; Family; Feedback; Fostering; Friends; Functional Magnetic Resonance Imaging; Future; Guidelines; Hand functions; Handedness; Healthcare; Human; Human Resources; Impairment; Individual; Insurance; Intervention; Ischemic Stroke; Link; Long-Term Care; Measures; Methods; Monitor; Morbidity - disease rate; Motor; Movement; Muscle; National Institute of Biomedical Imaging and Bioengineering; National Institute of Neurological Disorders and Stroke; Neurologic; Neuronal Plasticity; Neurosciences Research; Occupational; Outcome Measure; Outpatients; Paresis; Patients; Pattern; Peripheral; Play; Process; Protocols documentation; Quality of life; Randomized; Recommendation; Recovery; Recovery of Function; Recurrence; Rehabilitation device; Rehabilitation therapy; Research; Residual state; Robot; Role; Speech Therapy; Stroke; Structure; System; Techniques; Technology; Testing; Therapeutic; Therapeutic Intervention; Thinking; Time; Transcranial magnetic stimulation; Translations; United States; United States National Institutes of Health; Upper Extremity; Visit; Work; arm; base; behavior change; behavior measurement; brain computer interface; clinical practice; constraint induced movement therapy; cost; disability; experimental group; follow-up; functional electrical stimulation; functional independence; hand dysfunction; image guided therapy; improved; improved outcome; indexing; inpatient service; life time cost; mortality; motor function improvement; motor impairment; neural circuit; neuroimaging; new technology; novel; novel therapeutics; primary outcome; programs; prospective; real-time images; rehabilitative care; relating to nervous system; standard of care; stroke patient; stroke recovery; stroke rehabilitation; tool; upper limb hemiparesis; virtual reality; white matter

ABSTRACT Each year nearly 800,000 people suffer a new or recurrent stroke in the United States. Approximately 85% of these patients survive and require rehabilitation making it the leading cause of long-term disability in the U.S. Approximately 4 million Americans are living with the effects of stroke and millions of family/friends are caregivers. The estimated direct and indirect costs of stroke continue to escalate (e.g. in 2003 was $57 billion, 2008 was $65.5 billion, and for 2010 is estimated to be $73.7 billion). The mean lifetime cost of ischemic stroke in the US is estimated at $140,048, including inpatient care, rehab, and follow-up care. The majority of stroke costs are towards long-term care and rehabilitation (> $100,000/patient). Stroke rehabilitation in the latter stages of stroke is limited because most health care insurance pays only for limited rehabilitation visits (12-24 outpatient rehabilitation visits). Yet there is room for improvement in terms of decreasing morbidity and improving functional independence in these stroke patients, given that 1/3 of patients have some type of residual deficits. Although there are already several rehabilitation techniques aimed at stroke recovery including traditional physical-occupational-speech therapy, novel therapies such as constraint-induced movement therapy, robot- aided therapy, Transcranial Magnetic Stimulation (TMS), virtual reality (VR), a number of these suffer from issues of passive movement repetition, large equipment, personnel/time constraints, and high costs. Furthermore few harness brain plasticity to derive therapeutic interventions. The recommendations from the 2009 workshop sponsored by the NIH blueprint for neuroscience research heralded the translation of neuroplasticity as key to developing guidelines for effective clinical therapies in rehabilitation. Aim 1: To investigate the efficacy of BCI-FES vs. standard FES(current standard of care), as measured by changes in behavioral measures in stroke patients. A more recent development has been the use of a more active rehabilitation approach that harnesses brain plasticity in which brain thoughts inferred by EEG-based Brain Computer Interface (BCI)system are linked to functional electrical stimulation (FES) of the muscles to replace or assist function that is lost in neurologically impaired individuals. In recent animal and human studies, active stimulation by coordinating central brain activation with peripheral movement has been shown to elicit greater functional recovery than passive stimulation or peripheral movements. This is presumably through the faster formation of latent plastic neural circuits between central and periphery which an active approach would foster. This proposal investigates this novel BCI technology that adopts an active intervention approach, non-invasive and aims to facilitate recovery after brain injury by restoring brain function while improving corresponding motor function. Aims 2 & 3: To track brain reorganization changes and behavioral changes induced by BCI-FES vs. standard FES (current standard of care) in stroke patients. We also propose to study the mechanisms underlying functional recovery using this approach by collecting fMRI, EEG and DTI at different time points so as to monitor the extent of brain changes and to delineate the areas and tracts that are associated with improvement in behavior. Recent studies of stroke rehabilitation have suggested that ipsilesional and contralesional areas and tracts play an important role in the recovery process. These areas and tracts may be adaptive and essential for recovery whereas others may be maladaptive. Future studies using the novel stroke rehabilitation device can be aimed at facilitating adaptive areas/tracts and suppressing maladaptive areas/tracts in order to optimize recovery.

抽象的 在美国，每年有近80万人遭受新的或经常性的中风。约85％ 这些患者的生存并需要康复，这使其成为长期残疾的主要原因 美国约有400万美国人生活在中风和数百万 家人/朋友是照料者。中风的估计直接和间接成本继续升级（例如 2003年为570亿美元，2008年为655亿美元，2010年估计为737亿美元）。平均值 美国的缺血性中风的终生成本估计为140,048美元，包括住院护理，康复和 后续护理。大多数中风成本都是长期护理和康复（> $ 100,000/患者）。中风后期的中风康复受到限制，因为大多数医疗保健 保险仅用于有限的康复访问（12-24个门诊康复访问）。但是有空间 在这些中风的发病率下降和提高功能独立性方面的改善方面 鉴于1/3患者患有某种类型的残留缺陷。 尽管已经有几种旨在恢复中风的康复技术 传统的物理校园语音疗法，新的疗法，例如约束诱导的运动 治疗，机器人辅助治疗，经颅磁刺激（TMS），虚拟现实（VR），许多 这些遭受了被动运动重复，大型设备，人员/时间限制的问题， 和高昂的成本。此外，很少有利用脑可塑性来获得治疗性干预。 NIH蓝图为神经科学赞助的2009年研讨会的建议 研究预示着神经可塑性的翻译是制定有效临床指南的关键 康复治疗。 目标1：研究BCI-FES与标准FES（当前护理标准）的功效， 通过中风患者的行为度量的变化。 最新的发展是利用一种更积极的康复方法 大脑可塑性通过EEG基于大脑的大脑计算机界面（BCI）系统推断出的大脑可塑性是 与肌肉的功能电刺激（FES）有关，以替换或协助丢失的功能 神经学障碍的个体。在最近的动物和人类研究中，主动刺激 已证明与外周运动协调中央大脑激活可引起更大的功能 恢复比被动刺激或外围运动。大概是通过更快的速度 中央和周围之间的潜在塑料神经回路的形成 促进。该建议调查了采用主动干预方法的这种新颖的BCI技术， 非侵入性，旨在通过恢复大脑功能来促进脑损伤后康复 相应的电机功能。 目标2和3：跟踪BCI-FES VS引起的大脑重组变化和行为变化。 中风患者的标准FES（当前护理标准）。 我们还建议使用这种方法来研究功能恢复的基础机制 在不同时间点收集fMRI，EEG和DTI，以监视大脑变化的程度和 描述与行为改善相关的区域和区域。最近的研究 中风康复表明，ipsiles和对比区域和区域起着重要的作用 在恢复过程中的作用。这些领域和区域可能是适应性的，对于恢复至关重要 而其他可能是适应不良的。未来使用新型中风康复装置的研究可能是 旨在促进适应区/区域和抑制适应不良的区域/区域以优化 恢复。