CANDIDATE SCREENING FOR UPPER EXTREMITY NEUROPROSTHESIS AFTER STROKE

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。这项研究的目的是确定中风患者谁可能受益于植入式神经假体，恢复手臂和手的运动，通过电刺激瘫痪的肌肉。中风后上肢轻偏瘫患者必须具备以下特征，才有资格使用现有的神经假体：1）表面刺激可恢复上肢关节的完全主动活动范围（AROM），但自主活动范围有限; 2）如果存在导致AROM限制的肌肉张力过高，它可以通过药物或手术治疗减少到表面刺激恢复完全AROM的程度; 3）潜在候选者可以使用肌电控制策略和/或外部关节角度传感器和开关准确且可靠地调制命令信号; 4）当刺激由受试者调制时，表面刺激在恢复完全AROM方面保持有效。 将对表现出这些特征的受试者进行进一步评价，以确定哪些肌肉需要植入刺激和记录电极，以及需要哪些（如果有的话）增强外科手术。然后，希望进行神经假体植入的受试者将接受肌肉强化训练，在家中使用表面刺激器进行，并将入组涵盖手术和术后评价的单独研究方案。 入组本研究的受试者将因卒中发生上肢轻偏瘫，导致手臂和手的功能缺陷。他们可能有或可能没有高张性上肢肌肉。在进行进一步筛选评价之前，将使用运动范围和标准卒中损伤评估以及关键上肢肌肉的表面电刺激来确定是否需要治疗肌肉张力过高。本研究将提供三种标准的降低高眼压的选择：口服药物、神经松解和鞘内巴氯芬。

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. The purpose of this study is to identify stroke patients who may benefit from an implantable neuroprosthesis that restores arm and hand motion by electrically stimulating paralyzed muscles. The following characteristics must be true of individuals with post-stroke upper extremity hemiparesis for them to be eligible for the existing neuroprosthesis: 1) Surface stimulation restores full active range of motion (AROM) in upper extremity joints with limited voluntary AROM; 2) If muscle hypertonia that causes AROM limitations exists, it can be reduced with medical or surgical treatments to the extent that surface stimulation restores full AROM; 3) The potential candidate can accurately and reliably modulate a command signal using a myoelectric control strategy and/or external joint angle transducers and switches; 4) Surface stimulation remains effective in restoring full AROM when the stimulation is modulated by the subject. Subjects who exhibit these characteristics will be further evaluated to determine which muscles to implant with stimulating and recording electrodes, and what, if any, augmentative surgical procedures are needed. Subjects who then desire to proceed to neuroprosthesis implementation will be prescribed muscle strengthening exercises to do at home with a surface stimulator and will be enrolled in a separate research protocol covering the surgery and post-operative evaluations. Subjects enrolled in this study will have upper extremity hemiparesis due to stroke, with resulting functional deficits of the arm and hand. They may or may not have hypertonic upper extremity muscles. Range of motion and standard stroke impairment assessments, along with surface electrical stimulation of key upper extremity muscles will be used to determine whether treatment of muscle hypertonia is required before further screening evaluations are performed. Three standard hypertonia-reducing options will be available as part of this study: oral medications, neurolysis, and intrathecal baclofen.