Myoelectrolytically controlled device in acute rehabilitation after stroke

几乎30%的中风幸存者最初严重的手臂损伤未能实现手臂的充分恢复 功能，使他们能够独立进行日常生活活动。功能缺陷可以改善 通过将康复与有前途的新技术相结合。肌电控制设备利用弱 受影响的肌肉产生的电信号，并将其放大以激活设备中的电机。的 马达的运动增强了它们自身在与该马达相关联的关节中的意志运动。因此，我们认为， 该装置为使用者提供了移动其麻痹手臂所需的支撑。 肌电控制的矫形器，其通过提供 通过四种移动方式提供帮助。该a-Myopro用户可以训练与一个单一的模式，或多个 模式可以被组合以允许更复杂的单个或多关节运动的训练。因此，一个- Myopro为手臂功能受限的中风患者提供了一种独特的运动训练模式， 允许他们有意识地练习孤立的手臂运动，否则他们不能自己练习。 在中风发作后的最初几周内，受伤的大脑经历了几种神经机制， 这一过程被称为神经可塑性，旨在重组神经连接并修复受损的神经元。 受伤区域周围的组织。几项研究表明，在这一急性期的康复， 增强瘫痪手臂的功能结果，可能是通过调节升高的神经可塑性， 机制具体来说，已经有人提出，增强神经可塑性的新干预措施， 对于严重受损的中风幸存者，特别需要恢复机制。 该CDA 1提案的基本原理是探索肌电控制设备a-Myopro是否可以 增加了严重手臂缺陷的中风患者的急性康复。该研究还将调查， 与标准护理相比，应用α-Myopro将导致临床结果的更大增强。 由于神经可塑性在急性期增强，因此该研究旨在将神经生理学 随着在该人群中使用a-Myopro练习而获得的增强而变化。因此， 这项研究将测试这样一个前提，即在严重急性康复受试者中加入a-Myopro练习。 手臂损伤作为一种新的康复工具， 提高这些受试者的临床结局。慢性卒中受试者的初步数据支持 本研究的中心前提。我们发现接受18次治疗的慢性中风患者 使用Myopro的个体化实践显示出瘫痪臂的临床结果的改善。 为了在急性康复阶段验证我的假设，我提出了一项研究，10名急性缺血性卒中患者（2 - 中风后14天）将接受18次使用a-Myopro的个性化练习。的改善 通过临床测量测量的上肢损伤和功能将与先前的 报告了标准护理结果。将使用神经生理学和神经成像工具收集信息 在研究期间的神经可塑性变化。本CDA-1将告知是否实施- Myopro在急性康复中是可行的，并导致研究人群手臂功能的改善。 这个项目是我在过渡到临床神经康复领域的理想选择。具体来说，随着 在我主要导师和全面指导团队的帮助下，我将开始接受（1）临床结果方面的培训 脑卒中患者的测量，（2）神经康复研究中的神经生理学和神经影像学工具，（3） 中风的临床最佳实践和临床试验管理的准备;（4）成为 独立的临床研究者。我的项目与我的职业目标是成为一名领先的 退伍军人事务部医学中心临床神经康复研究员。

Almost 30 % of stroke survivors with initial severe arm impairment fail to achieve sufficient recovery of arm function to enable them to independently perform activities of daily living. Functional deficits can be improved by combining rehabilitation with promising new technologies. Myoelectrically controlled devices utilize the weak electrical signals generated by the affected muscles and amplify them to activate a motor in the device. The movement of the motor augments their own volitional movement in the joint associated with that motor. Hence, the device provides the user the support needed to move their paretic arm. a-Myopro is an adjustable myoelectrically controlled orthosis that facilitates movement of the paretic hand and elbow by providing assistance through four modes of movements. The a-Myopro user can train with a single mode, or multiple modes can be combined to allow for more complex training of individual or multi-joint movements. Thus, a- Myopro provides stroke subjects who have limited arm function a unique movement training paradigm that allows them to volitionally practice isolated arm movements that they otherwise cannot practice on their own. During the first weeks after the onset of stroke, the injured brain undergoes several neural mechanisms, a process known as neuroplasticity, that intend to reorganize the neural connectivity and repair the damaged tissue around the injury region. Several studies have revealed that rehabilitation during this acute period would enhance the functional outcome of the paretic arm presumably by modulating the heightened neuroplastic mechanism. Specifically, it has been suggested that novel interventions that enhance neuroplastic mechanisms of recovery are particularly needed for stroke survivors who are severely impaired. The rationale of this CDA1 proposal is to explore if the myoelectrically controlled device a-Myopro can be added to the acute rehabilitation of stroke subjects with severe arm deficits. The study will also investigate if application of a-Myopro would lead greater enhancement of clinical outcomes compared to standard care. Because neuroplasticity is heightened in the acute phase, the study aims to correlate the neurophysiological changes with the enhancement gained as a result of practicing with a-Myopro in this population. Thus, this study will test the premise that adding practice with a-Myopro to the acute rehabilitation of subjects with severe arm impairment acts as a novel rehabilitative tool that promotes the neuroplastic mechanisms of recovery to enhance clinical outcomes for these subjects. Preliminary data on chronic stroke subjects provides support for the central premise of this study. We have found that individuals with chronic stroke who receive 18 sessions of individualized practice using Myopro exhibit improvements in the clinical outcomes of the paretic arm. In this proposed study, to test my premise in the acute rehabilitation phase, ten subjects with acute ischemic stroke (2 – 14 days post stroke) will receive 18 sessions of individualized practice using a-Myopro. The improvements in upper extremity impairment and function measured by clinical measures will be compared to previously reported standard care results. Neurophysiological and neuroimaging tools will be used to collect information on the neuroplastic changes during the study period. This CDA-1 will inform whether implementation of a- Myopro in acute rehabilitation is feasible and leads to improvement in arm function in the study population. This project is ideal for me during my transition into clinical neurorehabilitation field. Specifically, with the help of my primary mentor and comprehensive mentoring team, I will begin to be trained in (1) clinical outcome measures for stroke subjects, (2) neurophysiological and neuroimaging tool in neurorehabilitation research, (3) clinical best practices in stroke and preparation for clinical trial management and (4) aspects to become an independent clinical researcher. My project is highly integrated with my career goal of becoming a leading investigator in clinical neurorehabilitation within the VA medical center.