A neuroprosthesis for seated posture and balance

用于坐姿和平衡的神经假体

• 批准号: 8486090
• 负责人: RONALD J TRIOLO
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8486090
• 关键词: Abdomen; Acceleration; Activities of Daily Living; Clinical; Clinical Trials; Communities; Conscious; Data; Disabled Persons; Environment; Equilibrium; Fall prevention; Flexor; Future; Generations; Health; Healthcare Systems; Hip region structure; Home environment; Implant; Intervention; Lateral; Leisure Activities; Life; Life Style; Manual wheelchair; Measures; Mechanics; Muscle; Paralysed; Pattern; Perception; Performance; Personal Satisfaction; Phase; Population; Posture; Preparation; Procedures; Recruitment Activity; Safety; Self Stimulation; Signal Transduction; Specific qualifier value; Speed; Spinal cord injury; Stimulus; Stroke; Surface; System; Telemetry; Veterans; Wheelchair propulsion; Wheelchairs; Wireless Technology; Work; base; falls; fear of falling; implantable device; improved; neuroprosthesis; new technology; programs; public health relevance; sensor; skeletal; social; telemetering

DESCRIPTION (provided by applicant): Spinal cord injury (SCI) can result in paralysis of the core trunk and hip musculature which compromises the ability to stabilize the torso while reaching, resist disturbances to sitting balance, and efficiently propel a manual wheelchair. Constant stimulation of the trunk and hip extensor muscles can positively alter seated posture, extend bimanual reach, restore erect sitting, and improve wheelchair propulsion mechanics at slow speeds and on level surfaces. However, continuously activating the trunk and hip extensors is unresponsive to the dynamically changing demands of many activities of daily living and does not contribute to attaining forward leaning postures or resisting rearward directed disturbances. First-generation systems also require users to intentionally select a discrete pattern of stimulation for each desired function from a fixed menu of pre-programmed options. The purpose of this study is to expand the functional impact of neuroprostheses for seated posture and balance by a) incorporating the abdominal and hip flexor muscles to enhance trunk stiffness through co-contraction with the extensors, b) synchronizing stimulation with the stroke cycle to improve wheelchair propulsion efficiency, c) providing automatic righting actions to maintain upright posture, prevent falls and extend forward reach, and d) integrating these approaches into an advanced sensor-driven trunk control system with currently available implantable devices in preparation for transitioning to new technologies suitable for clinical dissemination. The implanted EMG telemetry and expanded channel count of our second-generation implanted stimulator-telemeter (IST) will be utilized to implement advanced neuroprostheses for seated function. Two channels of EMG data will detect transitions between contact and return phases of propulsion and switch between appropriate stimulus patterns without conscious effort by the user. Performance of continuous co-activation of the hip/trunk flexor and extensor muscles will be compared to phasic activation of the muscles in terms of propulsion mechanics, efficiency, and subjective perception of effort on level and inclined surfaces and at various speeds. Control systems based on an inexpensive commercially available wireless 3D accelerometer will be implemented to detect impending forward or lateral falls and appropriately modulate stimulation to restore upright posture and sitting balance. Efficacy will be evaluated in terms of forward reach, rejection of disturbances, independence and safety of transfers, and both patterns of usage and fear of falling in the home and community environments. Complementary information from upper body EMG and trunk accelerations will be combined into a single control system to automatically regulate stimulation for self-righting and propulsion over various surfaces and speeds without intentional intervention by the user. Ability to discriminate between dynamic activities such as starts, stops, bumpy or inclined terrain and obstacle collisions will be determined. Usage patterns and measures of independence in the home and community will document the effects of the comprehensive control system. This translational project will establish the feasibility of a new intervention fr maximizing seated stability, facilitating personal mobility and enhancing the safety and functional independence of veterans with SCI, and in so doing define the most effective implementation for future clinical trials and widespread distribution throughout the VA healthcare system. PUBLIC HEALTH RELEVANCE: Spinal cord injury (SCI) significantly restricts access to life opportunities and compromises the ability to work, engage in social or leisure activities, and assume an independent and productive lifestyle. Activating the paralyzed hip and trunk muscles can promote healthy skeletal alignment, restore and maintain erect sitting postures, extend bimanual reach and the ability manipulate objects, prevent falls, improve the efficiency of manual wheelchair propulsion and facilitate transfers and other activities of daily living. This project is important because it specifies a comprehensive control system for restoring sitting posture and balance that can improve seated function by stiffening the trunk in task-dependent manners without conscious effort by the user. It is directly applicable to the health and well-being of disabled veterans who are over-represented in the SCI population.

描述(由申请人提供)： 脊髓损伤(SCI)会导致核心躯干和髋部肌肉系统瘫痪，从而影响伸手时稳定躯干的能力，抵抗坐着平衡的干扰，并有效地推动手动轮椅。持续刺激躯干和臀部伸展肌肉可以积极改变坐姿，延长双手伸展范围，恢复直立坐姿，并在低速和平坦的地面上改善轮椅推进机制。然而，持续激活躯干和髋关节伸展肌，对许多日常生活活动的动态变化需求没有反应，也无助于获得前倾姿势或抵抗向后定向的干扰。第一代系统还要求用户有意地从预先编程的选项的固定菜单中为每个所需功能选择离散的刺激模式。这项研究的目的是扩大神经假体对坐姿和平衡的功能影响，a)合并腹部和髋屈肌，通过与伸肌共同收缩来增强躯干僵硬，b)使刺激与中风周期同步，以提高轮椅的推进效率，c)提供自动扶正动作，以保持直立姿势，防止摔倒和 向前延伸，以及d)将这些方法集成到具有当前可用的植入式设备的高级传感器驱动的干线控制系统中，为过渡做准备 到适合临床推广的新技术。我们的第二代植入式刺激-遥测仪(IST)的植入式肌电遥测和扩展的通道计数将被用于实施先进的坐位功能神经假体。两个通道的肌电数据将检测推进的接触和返回阶段之间的转换，并在适当的刺激模式之间切换，而不需要用户有意识地努力。髋部/躯干屈肌和伸肌的持续协同激活的表现将与肌肉的阶段性激活进行比较，包括推进机制、效率和在水平和倾斜表面以及不同速度下的主观感觉。基于廉价的商用无线3D加速度计的控制系统将被实施，以检测即将到来的向前或横向跌倒，并适当地调节刺激，以恢复直立姿势和坐姿平衡。疗效将从向前伸展、抗扰、转让的独立性和安全性、使用模式和对跌落在家庭和社区环境中的恐惧两个方面进行评估。来自上半身肌电和躯干加速的互补信息将被结合到一个单一的控制系统中，以自动调节在不同表面和速度上的自我扶正和推进的刺激，而无需用户故意干预。将确定区分动态活动(如启动、停止、颠簸或倾斜的地形和障碍物碰撞)的能力。家庭和社区中的使用模式和独立性措施将记录综合控制系统的效果。这一翻译项目将确定一种新的干预措施的可行性，以最大限度地提高坐姿稳定性，促进个人行动能力，并增强患有脊髓损伤的退伍军人的安全性和功能独立性，从而确定未来临床试验的最有效实施方案，并在退伍军人管理局医疗保健系统中广泛分布。 公共卫生相关性： 脊髓损伤(SCI)极大地限制了获得生命机会的途径，损害了工作、参加社交或休闲活动的能力，并采取了独立和富有成效的生活方式。激活瘫痪的髋部和躯干肌肉可以促进健康的骨骼排列，恢复和保持直立的坐姿，延长双手伸展和操作物体的能力，防止摔倒，提高手动轮椅推进的效率，促进转移和其他日常生活活动。这个项目很重要，因为它指定了一个全面的控制系统，用于恢复坐姿和平衡，可以通过以依赖于任务的方式僵硬后备箱来改善坐姿功能，而不需要用户有意识地努力。它直接适用于残疾退伍军人的健康和福祉 在SCI人群中的比例过高。