Stroke Rehabilitation utilizing BCI technology

利用 BCI 技术进行中风康复

• 批准号: 10434746
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10434746
• 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; Persons; 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; 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.

摘要 在美国，每年有近80万人遭受新发或复发性中风。约85% 这些患者的生存和需要康复，使其成为长期残疾的主要原因， 美国大约有400万美国人生活在中风的影响下， 家人/朋友是照顾者。中风的估计直接和间接成本继续上升（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 在美国，缺血性卒中的终生费用估计为140，048美元，包括住院治疗、康复和 后续护理。中风的大部分费用用于长期护理和康复（> 100，000美元/患者）。中风后期的中风康复是有限的，因为大多数医疗保健 保险只支付有限的康复治疗（12-24次门诊康复治疗）。还有空座 在降低发病率和改善功能独立性方面， 患者，因为1/3的患者有某种类型的残余缺陷。 虽然已经有几种针对中风恢复的康复技术， 传统的物理-职业-语言治疗，新的治疗，如强制性运动 治疗，机器人辅助治疗，经颅磁刺激（TMS），虚拟现实（VR），一些 这些都存在被动运动重复、大型设备、人员/时间限制 和高成本。此外，很少有人利用大脑的可塑性来进行治疗干预。 2009年由NIH神经科学蓝图主办的研讨会的建议 研究预示着神经可塑性的翻译是制定有效的临床治疗指南的关键。 康复治疗。 目的1：研究BCI-FES与标准FES（现行标准治疗）的疗效， 中风患者行为指标的变化。 最近的一项发展是采用了一种更积极的康复方法， 脑可塑性，其中由基于EEG的脑机接口（BCI）系统推断的脑思想被 与肌肉的功能性电刺激（FES）相关联，以替代或辅助在运动中丧失的功能。 神经受损的人。在最近的动物和人类研究中， 协调中枢脑激活与外周运动已被证明可以引起更大的功能性 恢复比被动刺激或外周运动。这大概是通过更快的 在中枢和外周之间形成潜在的可塑性神经回路， 福斯特该提案研究了这种采用主动干预方法的新颖BCI技术， 非侵入性，旨在通过恢复脑功能，同时改善脑损伤后的恢复， 相应的运动功能。 目的2和3：跟踪BCI-FES与对照组诱导的脑重组变化和行为变化。 标准FES（现行护理标准）。 我们还建议使用这种方法研究功能恢复的机制， 收集不同时间点的fMRI、EEG和DTI，以监测大脑变化的程度， 描绘出与行为改善相关的区域和区域。最近的研究 中风康复已经表明，病灶同侧和对侧的区域和区域在中风康复中起着重要的作用， 在恢复过程中的作用。这些地区和地带可能具有适应性，对恢复至关重要 而另一些可能是适应不良的。使用新型中风康复设备的未来研究可以 旨在促进适应性区域/区域和抑制不适应性区域/区域， 复苏