Augmenting kinesthetic feedback to improve hemiparetic arm control after stroke

目前与中风后手臂康复相关的研究和临床工作主要集中在运动 再培训，有限的重点是对运动功能的体感缺陷的影响。这并不奇怪 因为如果没有意志的运动，手臂就没有多大用处。然而，躯体感觉缺陷是常见的 在对侧病变臂中，可能对功能运动控制的缺陷起重要作用。这 项目通过创造"感觉替代"来促进中风后运动功能恢复的目标 这些技术通过提供增强的运动反馈来重建对侧损伤臂的动觉反馈控制， 反馈到身体的一部分，大脑保留处理躯体感觉反馈的能力。的 本申请的目的是确定如何最好地合成和输送补充动觉 反馈，并测试其能力，以提高对侧臂中风后的感觉运动控制。 这项研究有两个目的。第一种方法寻求优化补充动觉反馈的传递， 增强中风后对侧手臂的伸展、稳定和操作动作。几种不同 肢体位置和速度的振动触觉反馈编码将被合成并应用于身体上的部位 保持躯体感觉状态变量和刺激部位的特定组合最好地增强 将在一个小的卒中队列中确定对侧病变臂和手的稳定和操作 幸存者本研究目的是检验同时包含位置和速度状态的补充反馈的假设 信息将最好地增强手臂控制并最好地减少手握力和手臂之间的异常耦合 稳定目标2，试图描述由于补充的扩展训练而积累的学习， 动觉反馈在三周的时间里，一小群中风幸存者将接受培训， 补充动觉反馈，以增强三维环境中的伸手抓握动作。我们测试 补充动觉反馈的扩展训练导致新的补偿技能的假设 这些动作序列可以推广到未经训练的动作序列，而这些动作序列有助于许多日常生活行为的成功。 完成后，该项目将确定如何最好地合成和提供补充感官 反馈改善有残余运动能力但受损的卒中幸存者对侧手臂控制， 在对侧病变臂缺乏本体感觉。这一贡献将是重要的，因为它开发了一个新的 辅助技术有可能改善许多中风幸存者对侧手臂的使用。这 这项建议是创新性的，因为它从实质上背离了现状，无论是在 中风后的身体康复和感觉替代领域，通过转移运动的重点， 重新训练以重新建立对侧损伤臂的实时闭环反馈控制。 该项目的成功完成将最终导致新颖的，可持续的可穿戴技术， 使许多中风幸存者能够恢复受损或丧失的对侧臂功能。

Current research and clinical efforts related to post-stroke arm rehabilitation focus primarily on motor retraining, with limited focus on the impact of somatosensory deficits on motor function. This is not surprising given that arms are not very useful without volitional movement. However, somatosensory deficits are common in the contralesional arm and may contribute importantly to deficits in the control of functional movement. This project advances the goal of promoting functional motor recovery after stroke by creating "sensory substitution" technologies that re-establish kinesthetic feedback control of the contralesional arm by delivering augmented feedback to a body part for which the brain retains the ability to process somatosensory feedback. The objective of this application is to determine how best to synthesize and deliver supplemental kinesthetic feedback, and to test its ability to enhance sensorimotor control over the contralesional arm post-stroke. This study has two Aims. The first seeks to optimize delivery of supplemental kinesthetic feedback to enhance reach, stabilization and manipulation actions of the contralesional arm post-stroke. Several different vibrotactile feedback encodings of limb position and velocity will be synthesized and applied to sites on the body retaining somatosensation. The specific combination of state variables and stimulation site that best enhance stabilization and manipulation with the contralesional arm and hand will be identified in a small cohort of stroke survivors. This Aim tests the hypotheses that supplemental feedback including both position and velocity state information will best enhance arm control and best reduce abnormal coupling between hand grip force and arm stability. Aim 2, seeks to characterize learning that accrues due to extended training with supplemental kinesthetic feedback. Over a period of three weeks, a small cohort of stroke survivors will train to use supplemental kinesthetic feedback to enhance reach-to-grasp actions in a 3-dimensional environment. We test the hypothesis that extended training with supplemental kinesthetic feedback leads to new compensatory skills that generalize to untrained action sequences that contribute to the success of many behaviors of daily living. Upon completion, this project will determine how best to synthesize and deliver supplemental sensory feedback to improve contralesional arm control in stroke survivors with residual motor capacity but impaired or absent proprioception in the contralesional arm. This contribution will be significant because it develops a new assistive technology with the potential to improve contralesional arm use in many stroke survivors. This proposal is innovative because it represents a substantive departure from the status quo, both in the field of physical rehabilitation after stroke and in the field of sensory substitution, by shifting the focus of motor retraining toward the re-establishment of real-time closed-loop feedback control of the contralesional arm. Successful completion of this project will ultimately lead to novel, continuously wearable technologies that will enable many stroke survivors to recover impaired or lost capabilities in the contralesional arm.