Boost: A pragmatic inpatient rehabilitation strategy for improving musculoskeletal arm recovery after stroke

六分之一的人会中风；超过一半的人会导致慢性上肢(UE)损伤。而当 强化康复减少损伤，多数个人动作练习不足 卒中后早期，可塑性增强。我们的假设是UE存在一个阈值水平 汽车驱动需要刺激真正的UE恢复，但个人通常不会超过这一门槛 在住院康复期间。为了解决这个问题，弗林特康复中心和加州大学欧文分校提议测试一种新颖、务实的 使严重手臂损伤患者能够增加UE运动的康复策略 中风后要早点开车。我们将利用一项无处不在的技术-手动轮椅 基于两个关键的观察。第一个是Feys等人的一项关键研究。有100名亚急性疾病住院患者 用受损的手臂反复向前伸手，在摇椅上摇晃自己-500- 每天1000次；这些患者的UE Fugl-Meyer(FM)评分增加幅度明显更大，为17 与对照组相比，进行了五年的随访。这是一个显著的效果，但这种疗法仍然 未在常规临床实践中实施。第二个观察：70%的中风住院患者(几乎所有 有更严重的损伤)每天花几个小时被动地坐在手动轮椅上， 通常他们偏瘫的手臂被绑在手臂槽里。此外，当他们坐在轮椅上移动时， 他们被推搡，或被教导如何使用他们“好”的胳膊和腿。我们的核心理念是用一种新颖的、可移动的 轮椅扶手称为Boost，使住院患者能够进行重复的手臂治疗 坐在轮椅上的飞人。Boost快速进入轮椅框架，就像传统的 轮椅扶手，并结合了创新的直线机构，使UE激活在两个 模式：1)椅子保持静止，或2)使用者推动其 手臂受伤的轮椅。这后一种模式转化为“好臂+好腿”的补偿方式 轮椅推进技术转变为“好臂+好腿+残臂”推进。我们假设 在住院治疗期间使用Boost将使中风患者能够达到阈值 在常规练习中要求UE电机驱动水平以促使UE恢复，显著提高 与常规治疗相比，恢复情况更好。我们已经对功能原型进行了初步测试 以积极的结果推动。因此，对于这个直接到第二阶段的SBIR，我们的目标是：目标1)开发 具有临床和最终用户反馈的商业就绪型Boost模型；目标2)执行随机 58例亚急性卒中住院患者的Boost对照试验。在项目结束时，我们将拥有 验证了Boost的临床可行性和有效性，并对其进行了生产和批量分配的优化。 如果我们的计划成功，我们将证明基于轮椅的“摇摆疗法”可以起到帮助作用。 患者通常达到促使UE真正恢复所需的感觉运动驱动的阈值水平。

One in six people will have a stroke; over half will incur chronic upper extremity (UE) impairment. While intensive rehabilitation reduces impairment, most individuals do not perform enough movement practice early after stroke when plasticity is heightened. Our hypothesis is that there is a threshold level of UE motor drive needed to provoke true UE recovery, yet individuals do not routinely exceed this threshold during inpatient rehabilitation. To solve this, Flint Rehab and UC Irvine propose to test a novel, pragmatic rehabilitation strategy for enabling individuals with even severe arm impairment to increase UE motor drive early after stroke. We will leverage a ubiquitous piece of technology–the manual wheelchair–based on two key observations. The first is a pivotal study by Feys et al. that had 100 inpatients with subacute stroke rock themselves in rocking chairs by repetitively reaching forward with their impaired arm 500- 1000 times per day; these patients had significantly greater increases in UE Fugl-Meyer (FM) score of 17 points at a five-year follow up compared to control. This is a remarkable effect, yet this therapy remains unimplemented in routine clinical practice. A second observation: 70% of stroke inpatients (and nearly all with more severe impairments) spend several hours each day sitting passively in manual wheelchairs, often with their paretic arm strapped into an arm trough. Further, when they move in their wheelchair, they are pushed, or taught to use their “good” arm and leg. Our core idea is to use a novel, moveable wheelchair armrest called Boost to enable inpatients to perform the repetitive arm therapy validated by Feys while seated in their wheelchair. Boost quickly clicks into a wheelchair frame just like a conventional wheelchair armrest and incorporates an innovative linear mechanism that enables UE activation in two modes: 1) with the chair remaining stationary, or 2) with the user contributing to propelling their wheelchair with their impaired arm. This latter mode transforms the "good arm + good leg" compensatory wheelchair propulsion technique into “good arm + good leg + impaired arm” propulsion. We hypothesize that use of Boost during inpatient therapy will enable individuals with stroke to achieve the threshold level of UE motor drive required to provoke UE recovery in routine practice, significantly improving recovery compared to conventional treatment. We have already pilot tested a functional prototype of Boost with positive results. Thus, for this Direct-to-Phase II SBIR our aims are to: Aim 1) Develop a commercial-ready model of Boost with clinical and end-user feedback; Aim 2) Perform a randomized controlled trial of Boost with inpatients with subacute stroke (N=58). At project end, we will have validated the clinical feasibility and efficacy of Boost and optimized it for production and mass distribution. If our plan is successful, we will have demonstrated that wheelchair-based “rocking therapy” can help patients routinely achieve the threshold level of sensory motor drive needed to provoke true UE recovery.