ROBOTIC STEP TRAINING

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。这个项目将开发一种机器人步道训练器，可以用来重新训练脊髓损伤的人走路。该设备将包括可以控制和响应腿部运动的轻型腿部机器人，以及可以控制和响应肢体负荷和躯干运动的体重支持（BWS）系统。这些腿部机器人被称为“亚瑟”（人类康复行走辅助机器人工具）。BWS机器人系统由“OS”（头顶支撑）和“PAM”（骨盆辅助机械手）组成。机器人控制算法的设计将为行走提供动力辅助，并根据需要增强对脊髓的感觉输入，以便在跑步机上负重运动训练（BWST）中促进步伐的重新学习。该设备将在加州大学洛杉矶分校开发，并在加州大学洛杉矶分校的脊髓损伤受试者中进行测试。UCI的团队负责设计和制造该设备，并在UCI的未受损受试者中进行初步测试。加州大学洛杉矶分校的研究小组将在两项小型试点研究中对脊髓损伤的志愿者进行测试。第一项研究将比较患者在机器人装置上进行运动训练和在BWST下进行手动（治疗师为基础的）运动训练时的肌电图模式。第二项研究将确定使用机器人设备进行运动训练是否能改变患者独立踏上跑步机的能力。我们假设机器人训练在诱导规范的肌电图模式方面至少与人工训练一样有效，将诱导独立跑步机行走的改善，并将显著减少与运动训练相关的劳动力和成本。如果是这样，该项目开发的技术将极大地提高脊髓损伤后步态康复的技术和科学水平。它还将直接使数千名脊髓损伤的美国公民受益，并大大降低与脊髓损伤康复相关的经济成本。这个项目的科学依据是脊髓具有非凡的学习能力。在没有椎上输入的情况下，腰椎脊髓可以学会站立（Pratt等，1994；de Leon等，1999b）和行走（Lovely等，1986；Barbeau和Rossignol, 1987； Lovely等，1990；Edgerton等，1991；Hodgson等，1994；Belanger等，1996；Edgerton等，1997b； de Leon等，1998；de Leon等，1999a； de Leon等，1999c）。如果经过适当的训练，脊髓的学习能力对成千上万的脊髓损伤患者来说是一项极其重要的发现，因为它可能意味着被限制在轮椅上还是能够站起来走几步的区别。教导脊髓迈步本身具有直接的临床应用，也可以在提高其他潜在的脊髓损伤治疗干预措施（如细胞生长、细胞工程和药物治疗）的疗效方面发挥关键作用。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This project will develop a robotic step trainer that can be used to retrain individuals with spinal cord injury to walk. The device will consist of lightweight leg robots that can control and respond to leg movement, and a body weight support (BWS) system that can control and respond to limb loading and torso movement. The leg robots are called "ARTHur" (Ambulation-assisting Robotic Tool for Human Rehabilitation). The BWS robotic system is comprised of "OS" (Overhead Support) and "PAM" (Pelvis Assist Manipulator). Robotic control algorithms will be designed that provide power assistance for stepping and enhance sensory input into the spinal cord on an as-needed basis in order to facilitate step relearning during locomotor training with body weight support on a treadmill (BWST). The device will be developed at UCI and tested with spinal cord injured subjects at UCLA. the team at UCI is responsible for designing and building the device, and initial testing with unimpaired subjects at UCI. The team at UCLA will test the device with volunteers with spinal cord injury in two small pilot studies. The first study will compare electromyographic patterns in patients during locomotor training on the robotic device and during manual (therapist-based) locomotor training with BWST. The second study will determine whether locomotor trianing using the robotic device can induce changes in a patient's ability to independently step on a treadmill. We hypothesize that robotic training will be at least as effective as manual training in inducing normative EMG pattern, will induce improvements in independent treadmill stepping and will significantly reduce the labor and costs associated with locomotor training. If so, the technology developed in this project will dramatically improve the state-of-the-art in technology and science for gait rehabilitation following spinal cord injury. It will also directly benefit thousands of U.S. citizens with spinal cord injury, and substantially reduce economic costs associated with rehabilitation from spinal cord injury. The scientific rationale for this project is that the spinal cord has a remarkable capacity to learn. The lumbar spinal cord can lear to stand (Pratt et al. 1994; de Leon et al. 1999b) and to step (Lovely et al. 1986; Barbeau and Rossignol 1987; Lovely et al. 1990; Edgerton et al. 1991; Hodgson et al. 1994; Belanger et al. 1996; Edgerton et al. 1997b; de Leon et al. 1998; de Leon et al. 1999a; de Leon et al. 1999c) in the absence of supraspinal input. The ability of the spinal cord to learn, if appropriately trained, is an extremely important finding for tens of thousands of people with spinal cord injury, as it could mean the difference between being confined to a wheelchair or being able to stand and take some steps. Teaching the spinal cord to step has immediate clinical application in itself and can also play a crucial role in enhancing the efficacy of other potential therapeutic interventions for spinal cord injuries, such as cell growth, cell engineering and pharmacological treatments.