Cognitive-based Rehabilitation Platform of Hand Grasp after Spinal Cord Injury using Virtual Reality and Instrumented Wearables

使用虚拟现实和仪器化可穿戴设备的脊髓损伤后手部抓握认知康复平台

• 批准号: 10326389
• 负责人: NOAM Y. HAREL
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10326389
• 关键词: Achievement; Activities of Daily Living; Auditory; Award; Binding; Cervical; Cervical spinal cord injury; Chronic; Cluster Analysis; Cognition; Cognitive; Conscious; Coupled; Cues; Custom; Devices; Elbow; Electromyography; Environment; Esthesia; Feedback; Feeling; Future; Goals; Hand; Hybrids; Impairment; Isometric Exercise; Learning; Link; Machine Learning; Measures; Modality; Motivation; Motor; Movement; Muscle; Nervous System Trauma; Neurosciences; Outcome; Paralysed; Participant; Pathway interactions; Pattern; Perception; Performance; Persons; Physical Rehabilitation; Physical therapy; Physical therapy exercises; Positioning Attribute; Process; Quality of life; Reading; Real-Time Systems; Rehabilitation device; Rehabilitation therapy; Research; Resistance; Secure; Self-Help Devices; Sensory; Services; Shapes; Shoulder; Speed; Spinal cord injury; Stroke; Subconscious; Tactile; Techniques; Technology; Tendon structure; Testing; Therapeutic; Time; Touch sensation; Training; Translating; Traumatic Brain Injury; Upper arm; Variant; Veterans; Visual; Work; algorithm training; arm; base; cognitive enhancement; cohort; computerized; efficacy testing; exercise rehabilitation; exoskeleton; functional electrical stimulation; functional outcomes; grasp; hand dysfunction; hand grasp; hand rehabilitation; haptic feedback; haptics; improved; innovation; instrument; machine learning algorithm; motor learning; multisensory; neuromuscular; novel; operation; physical process; powered exoskeleton; powered prosthesis; rehabilitation research; research and development; sensor; sensory feedback; skills; sound; synergism; time interval; vibration; virtual; virtual reality; virtual reality environment; visual feedback; wearable device

PROJECT SUMMARY Spinal cord injury (SCI) at the cervical level impairs hand function and the ability to engage the environment. As a result, the ability to perform activities of daily living can be severely compromised, directly leading to reduced quality of life. Physical therapy is still the primary pathway to restore functional abilities after SCI. The physical rehabilitation process requires commitment by the participant to achieve meaningful gains in function. Rehabilitation approaches that are cognitively engaging can facilitate greater commitment to practice and improved movement learning. We propose to develop innovative platforms that utilize virtual reality (VR) and instrumented wearables that enhance cognitive factors during motor learning of hand grasp and reach after SCI. These factors include greater sense of agency, or perception of control, and multi-sensory feedback. Sense of agency is implicated with greater movement control, and various sensory feedback modalities (visual, audio, and haptic) are proven effective in movement training. However, these factors are not well considered in traditional physical therapy approaches. We have developed two novel cognitive-based platforms for rehabilitating grasp and reach function. We propose to test each platform in Veterans with chronic SCI at the cervical level. In Aim 1, we will investigate how our first platform, the “cognition” glove, may improve functional grasp. This glove includes force and flex sensors that provide inputs to a machine learning algorithm trained to predict when secure grasp is achieved. The glove alerts the user of secure grasp through onboard sensory modules providing visual (LED), audio (beeper), and tactile (vibrator) feedback. During training, feedback is provided at gradually shorter time-intervals to progressively induce agency based on the neuroscience principle of ‘intentional binding’. This principle suggests that with greater agency, one perceives their action (i.e., secure grasp) is more coupled in time to a sensory consequence (i.e., glove feedback). Our glove is user-ready, and now has compatibility with customized VR applications to provide enhanced sensory feedback through engaging and customized visual and sound alerts. We hypothesize that enhanced feedback in VR will produce even greater improvements in grasp performance than onboard feedback alone. In Aim 2, we investigate how Veterans with SCI may learn greater arm muscle control during virtual reaching. We have developed a “sensory” brace that provides isometric resistance to one arm to elicit electromyography (EMG) patterns that can drive a virtual arm. The person receives visual feedback from VR and muscle tendon haptic feedback from the brace during training. Tendon stimulation can elicit movement sensations that modulate muscle activation patterns. The VR feedback will provide conscious movement training cues while vibration feedback will subconsciously elicit more distinct EMG patterns based on cluster analysis. We hypothesize that the promotion of distinct EMG patterns, achieved by maximizing inter-cluster distances, will improve performance of a reach-to-touch task. Performance of both the grasp and reach task in each Aim is assessed according to metrics that describe the timing, efficiency, and accuracy of movement. For a future MERIT proposal, we intend to integrate these platforms to train better operation of powered assistive devices, including a hybrid (motor power and functional electrical stimulation of muscle) exoskeleton of the hand. Importantly, the concept of strengthening cognitive agency and learning of movement using wearable technology, multi-sensory feedback, and virtual reality during physical training will be applicable to all forms of neuromuscular impairment, including stroke and traumatic brain injury in addition to SCI. Our team is ideally positioned to take the next steps in developing, translating, and applying this technological approach, which matches the Rehabilitation Research and Development Service’s goals.

项目摘要 宫颈水平的脊髓损伤（SCI）会损害手部功能和参与环境的能力。作为 结果，进行日常生活活动的能力可能会严重损害，直接导致降低 生活质量。物理治疗仍然是SCI后恢复功能能力的主要途径。身体 康复过程需要参与的承诺，以实现有意义的功能收益。 认知参与的康复方法可以促进对实践和 改善运动学习。我们建议开发利用虚拟现实（VR）和 仪器可穿戴设备，可在Sci后手动掌握和触及运动过程中增强认知因素。 这些因素包括更大的代理意识，对控制的感知以及多感觉反馈。感觉 代理的动作控制和各种感觉反馈方式（视觉，音频，， 和Hattic）在运动训练中被证明有效。但是，这些因素并不是很好地考虑 传统的物理疗法方法。我们已经开发了两个基于认知的新型平台 恢复掌握和触及功能。我们建议在以慢性SCI的退伍军人中测试每个平台 宫颈水平。在AIM 1中，我们将研究我们的第一个平台“认知”手套如何改善功能 抓牢。该手套包括力和弹性传感器，可为机器学习算法提供输入。 预测何时实现安全掌握。手套警告用户安全掌握在车载感官上 提供视觉（LED），音频（蜂鸣器）和触觉（振动器）反馈的模块。在培训期间，反馈是 根据神经科学原理逐渐降低时间间隔，以逐步诱导代理 “故意约束”。该原则表明，通过更大的代理，人们就会意识到自己的行动（即安全 掌握时间更多地与感官后果（即手套反馈）相结合。我们的手套已准备就绪，并且 现在与自定义的VR应用程序兼容，以通过参与来提供增强的感觉反馈 以及定制的视觉和声音警报。我们假设VR中增强的反馈甚至会产生 与仅在机载反馈中相比，掌握性能的改善要大。在AIM 2中，我们调查了如何 具有SCI的退伍军人可以在虚拟到达期间学习更大的手臂控制。我们已经开发了一种“感官” 对一只手臂具有施加肌电图（EMG）模式的均衡性的支撑物，该模式可以驱动 虚拟臂。该人从VR和肌肉肌腱触觉反馈中收到视觉反馈。 在训练期间。肌腱刺激可以引起运动感觉，以调节肌肉激活模式。 VR反馈将提供有意识的运动培训线索，而振动反馈将在潜意识中 基于群集分析引起更不同的EMG模式。我们假设促进不同的EMG 通过最大化集群间距离实现的模式将提高到达任务的性能。 每个目标中的掌握和触及任务的执行都根据描述的指标进行评估 运动的时机，效率和准确性。对于未来的优点建议，我们打算将这些提议整合在一起 平台以训练更好的电力辅助设备运行，包括混合动力（电动机和功能性 肌肉的电刺激）手的外骨骼。重要的是，加强认知的概念 使用可穿戴技术，多感官反馈和虚拟现实的机构学习和学习运动期间 体育训练将适用于所有形式的神经肌肉障碍，包括中风和创伤性大脑 除了科学外，受伤。我们团队的理想位置可以采取下一步的发展，翻译和 应用这种技术方法，该方法与康复研究与开发服务局相匹配 目标。