Evaluation of robot assisted neuro-rehabilitation

机器人辅助神经康复的评价

• 批准号: 8668997
• 负责人: CHRISTOPHER T BEVER
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8668997
• 关键词: Activities of Daily Living; Acute; Adherence; Adopted; Adult; Affect; Age; Area; Behavior Therapy; Behavioral; Brain; Brain Diseases; Caring; Chronic; Clinical; Clinical Data; Data; Development; Devices; Diagnosis; Disease; Distal; Elbow; Elements; Enrollment; Evaluation; Exercise; Functional disorder; General Population; Goals; Grant; Guidelines; Hand; Health; Health Insurance; Healthcare Systems; Home Nursing Care; Home environment; Impairment; Incidence; Individual; Inpatients; Intervention; Joint structure of shoulder region; Lead; Lesion; Life; Limb structure; Literature; Longevity; Maps; Measures; Methods; Mission; Modeling; Motor; Motor Activity; Motor Cortex; Movement; Multiple Sclerosis; Muscle; Nervous system structure; Neurologic; Neurorehabilitation; Occupational Therapy; Outcome; Outcome Measure; Parkinsonian Disorders; Patients; Performance; Persons; Phase; Physical Rehabilitation; Physical Restraint; Physiology; Pilot Projects; Play; Population; Positron-Emission Tomography; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Recurrence; Rehabilitation therapy; Research; Resources; Robot; Robotics; Role; Shoulder; Side; Single-Blind Study; Specificity; Stroke; Surrogate Markers; Survivors; System; Testing; Therapeutic; Therapeutic Intervention; Time; Training; Training Programs; Transcranial magnetic stimulation; Translations; Traumatic Brain Injury; Treatment Protocols; Unemployment; United States; Upper Extremity; Upper arm; Veterans; Work; Wrist; arm; base; care delivery; care seeking; chronic stroke; constraint induced therapy; cost; diaries; disability; effective therapy; follow-up; functional improvement; grasp; hemiparesis; hemiparetic stroke; hospital readmission; improved; improved functioning; kinematics; loss of function; motor function recovery; motor impairment; neuromechanism; performance tests; post stroke; rehabilitation service; response; robot assistance; screening; skills; standard of care; stroke recovery; treatment strategy; trial comparing

Upper extremity dysfunction is an important part of the disability caused by stroke, the leading cause of long term disability in adults. An evolving body of research suggests that specific rehabilitation interventions can improve functioning in an impaired arm even after sustained loss of function. We and others have shown that robot assisted rehabilitation can reduce arm impairment compared to baseline. We have now shown that robot assisted rehabilitation can reduce arm impairment in a randomized, single-blind trial compared to conventional occupational therapy. Studies of robotic training and also constraint-induced therapy suggest that specific training on functional tasks may enhance to translation of training gains into improved function. We propose to study the value of adding a functional training session (which we refer to as transition to task training or TTT) to robotic training. One published study suggests that robotic training induces changes in cortical motor maps. We will conduct studies of cortical motor excitability in our patients before and after training to investigate this issue. Criteria for determining the maximum benefit of robotic training have not yet been developed. One approach would be to conduct conventional upper extremity evaluations during the course of therapy but that would significantly increase therapist time. The robots record the assistance provided to patients during each training session and we will examine whether that data might be used on an ongoing basis to evaluate patient benefit. Primary hypothesis: TTT immediately following each robotic training session leads to greater functional improvement than robot- assisted training alone for patients with chronic upper extremity dysfunction due to hemi-paretic stroke. Secondary mechanistic hypothesis: Robotic training results in alterations in cortical motor excitability as detected by transcranial magnetic stimulation. Secondary clinical hypothesis: Robot kinematic data will reflect the functional changes seen in the training and that this information can be used clinically to determine when a patient has reached maximum benefit from robotic training. In order to test these hypotheses we propose a randomized, single-blind trial comparing 36-60 minute robotic training sessions with 36 training session consisting of 45 minutes of robotic training and 15 minutes of TTT training. Outcomes will include upper arm functional assessments, the results of transcranial magnetic stimulation and robot generated kinematic data. Page 1

上肢功能障碍是脑卒中致残的重要组成部分，是导致脑卒中的主要原因 导致成人长期残疾的原因。不断发展的研究表明，特定的 即使在持续丧失后，康复干预也可以改善受损手臂的功能 的功能。我们和其他人已经证明机器人辅助康复可以减少手臂 与基线相比的损害。我们现在已经证明机器人辅助康复可以 与传统方法相比，在随机、单盲试验中减少手臂损伤 职业治疗。机器人训练和约束诱导疗法的研究表明 针对功能任务的具体培训可能会增强将培训成果转化为改进的成果 功能。我们建议研究增加功能训练课程的价值（我们将其称为 到任务训练（TTT）到机器人训练的过渡。一项已发表的研究表明 机器人训练会引起皮质运动图的变化。我们将进行皮质研究 我们对患者训练前后的运动兴奋性进行了调查，以调查这个问题。标准 确定机器人训练的最大效益尚未开发出来。一种方法 将在治疗过程中进行常规上肢评估，但是 这将显着增加治疗师的时间。机器人记录提供的帮助 在每次培训课程期间，我们都会检查这些数据是否可以用于 持续评估患者利益的基础。主要假设：TTT 紧随每个 机器人训练课程比机器人辅助训练带来更大的功能改善 单独用于因偏瘫性中风而导致慢性上肢功能障碍的患者。 次要机制假设：机器人训练导致皮质运动的改变 通过经颅磁刺激检测到的兴奋性。次要临床假设： 机器人运动学数据将反映训练中看到的功能变化，并且这 信息可在临床上用于确定患者何时达到最大益处 来自机器人训练。为了检验这些假设，我们提出了一种随机、单盲的方法 试验将 36-60 分钟的机器人训练课程与由 45 分钟组成的 36 次训练课程进行比较 分钟的机器人训练和 15 分钟的 TTT 训练。结果将包括上臂 功能评估、经颅磁刺激和机器人生成的结果 运动学数据。 第1页

项目成果

A Clinically Relevant Method of Analyzing Continuous Change in Robotic Upper Extremity Chronic Stroke Rehabilitation.

分析机器人上肢慢性中风康复持续变化的临床相关方法。

• DOI: 10.1177/1545968315620301
• 发表时间: 2016
• 期刊: Neurorehabilitation and neural repair
• 影响因子: 4.2
• 作者: Massie,CrystalL;Du,Yue;Conroy,SusanS;Krebs,HIgo;Wittenberg,GeorgeF;Bever,ChristopherT;Whitall,Jill
• 通讯作者: Whitall,Jill