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Effect of Upper Arm Support on the Hemiparetic Arm

上臂支撑对偏瘫手臂的影响

基本信息

批准号：
9397981
负责人：
Matthew Williams
金额：
--
依托单位：
LOUIS STOKES CLEVELAND VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-01-01 至 2018-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9397981
关键词：
Activities of Daily Living Address Afghanistan Area Beer Caregivers Chronic Clinical Conflict (Psychology)Dependence Development Devices Drops Effectiveness Elbow Electric Stimulation Equilibrium Exhibits FPS-FES Oncogene Fingers Flexor Force of Gravity Forearm Future Generations Goals Hand Hand functions Impairment Individual Intervention Iraq Isometric Exercise Joints Kinetics Lead Lifting Limb structure Location Measures Motion Motor Movement Muscle Nervous System Trauma Paresis Patients Pattern Performance Persons Population Research Robotics Self-Help Devices Shoulder Signal Transduction Stroke Support System System Testing Time Translations Traumatic Brain Injury Upper Extremity Upper arm Veterans Walking Wheelchairs Withdrawal Work Wrist arm arm function arm paresis chronic stroke clinically relevant design experimental study health administration hemiparesis hemiparetic stroke improved kinematics light weight meetings novel post stroke recruit robot assistance robotic device social spasticity stroke survivor synergism

项目摘要

Moderate to severe hemiparesis as a result of stroke can have a significant impact upon many common activities of daily living (ADLs), resulting in significant dependence on caregivers. One common occurrence in stroke is the development of abnormal muscle synergies where the elbow, wrist, and fingers involuntarily flex and close when the patient exerts effort to lift the arm. This results in a loss of reach area and closing of the hand, greatly impairing its use. However, it has been shown that when the arm is supported and an outside force is used to lift the arm, this involuntary activity is not elicited. Any intervention to restore arm and hand function in individuals with hemiparesis due to severe to moderate stroke must first address the alleviation of this shoulder-elbow flexion synergy. The objective of the proposed work is to demonstrate the effectiveness of active support of the arm proximal to the elbow to assist shoulder abduction with the long-term goal of developing a small, worn, robotic assistance system. By using an external device rather than the person's voluntary effort to counter gravity, the effects of the shoulder-elbow flexion synergy will be significantly reduced; potentially allowing the user's retained voluntary movement control and strength to be effective. While earlier work has used arm support at the forearm or wrist to show a reduction in flexion synergy, this arrangement is not amenable to a worn device. The research proposed will be achieved through meeting two Specific Aims. The first is to characterize the kinetics, kinematics, and functional capabilities of the post-stroke hemiparetic arm while being supported. This will consist of experiments to test subjects' abilities to produce force isometrically, reach throughout the workspace in front of them, and open the hand with and without arm support provided by a commercially available robotic arm. The second Aim will be to quantify the changes in muscle activity as a result of reduction in abnormal flexion synergy afforded by proximal arm support. This Aim will serve to measure the timing and magnitude changes of EMG signals of the arm flexors as they relate to shoulder muscle EMG activity and quantify and demonstrate the changes in muscle activity that lead to a reduction in abnormal flexion synergy. Similar to Aim 1, EMG patterns will be compared between the gravity supported and the unsupported conditions. The work proposed represents a novel placement of arm support to reduce flexion synergies. This work is critical to the development of future arm assistance systems for individuals with hemiparesis as a result of stroke. By moving the location of the support closer to the body, a lightweight, wearable, clinically deployable, and user acceptable arm support system can be developed in later projects.

中风导致的中到重度偏瘫可以对许多人产生重大影响日常生活中的常见活动(ADL)，导致严重依赖照顾者。一中风中常见的是肘部肌肉协同发展异常，当病人用力抬起手臂时，手腕和手指不由自主地屈曲和合拢。这导致伸展区域的丧失和手的闭合，极大地影响了其使用。然而，它一直是证明了当手臂被支撑并使用外力抬起手臂时，这是无意识的不会引发活动。任何旨在恢复手臂和手功能的干预措施重度至中度中风所致的偏瘫必须首先解决肩肘的缓解问题屈曲协同作用。拟议工作的目标是证明积极支持ARM的有效性肘部近端帮助肩部外展，长期目标是发展一种小的，破旧的机器人辅助系统。通过使用外部设备而不是个人的自愿努力为了对抗重力，肩肘屈曲的协同效应将显著降低；潜在地允许用户保留的自愿运动控制和力量有效。虽然早期的研究使用前臂或手腕的手臂支撑来显示屈曲程度的减少协同效应，这种安排不适用于磨损的设备。拟议的研究将通过满足两个具体目标来实现。第一个是描述中风后偏瘫手臂的动力学、运动学和功能能力在得到支持的同时。这将包括测试受试者产生力量的能力的实验等距离地，伸手穿过他们前面的工作区，用手和不用手来张开手由市面上出售的机械臂提供的手臂支撑。第二个目标将是量化由于异常屈曲协同能力的降低而导致的肌肉活动的变化近臂支撑。这一目标将用于测量肌电的时间和幅度的变化手臂屈肌的信号，因为它们与肩部肌肉肌电活动有关，并量化和显示肌肉活动的变化，导致异常屈曲协同能力的降低。与目标1类似，我们将比较重力支撑和非重力支撑下的肌电模式条件。这项工作提出了一种新的手臂支撑位置，以减少屈曲协同效应。这这项工作对未来偏瘫患者手臂辅助系统的发展至关重要作为中风的结果。通过将支撑件的位置移动到更靠近身体的位置，临床可部署的、用户可接受的ARM支持系统可以在以后的项目中开发。