Brain-computer interface-functional electrical stimulation for stroke recovery

项目摘要 仅在美国就有超过700万中风幸存者，每年约有795，000例新发病例。尽管 即使采用最好的物理治疗，30-60%的中风幸存者仍然受到步态功能障碍的影响，其中 足下垂通常是主要原因。鉴于中风后步态障碍仍然没有得到最佳解决， 需要能够提供持久的神经和功能改善的新方法。 脑机接口（BCI）技术可能是这样一种新的方法。BCI技术使“直接 大脑控制”的外部设备，如辅助设备和假肢，通过翻译大脑电生理学， 校准信号（例如EEG）转换为控制信号。当BCI系统与功能性电刺激集成时 (FES)系统，它们可用于提供一种新的物理治疗，以改善中风后的运动功能。BCI- FES系统被假设为刺激赫布可塑性过程（其中“神经元一起放电，连接 一起”），这种方法可能导致中风后的功能恢复超过传统的理疗- - 是的申请人的初步研究表明，将该技术应用于中风后足下垂是安全的 并且可以通过神经过程改善步态功能。因此，这需要进一步调查：1。确定是否 BCI-FES治疗可以为慢性脑卒中足下垂患者提供持久的步态功能改善; 2.确定 影响BCI-FES治疗效果的因素; 3.明确阐明潜在的神经修复机制。 首先，一项针对慢性中风所致足下垂患者的II期临床试验将比较BCI的效果， FES背阔肌治疗与剂量和强度匹配的标准物理治疗（目的1）。比较 两组之间的步态速度和其他次要结果指标的改善将测试 假设BCI-FES治疗提供的功能和神经学增益超过传统物理学治疗， 离子疗法它还将确定哪些方面的步态障碍是最好的解决与BCI-FES治疗 与传统的物理疗法相比。受试者的基线特征（步态速度， 背侧肌功能、运动诱发电位、脑电图特征、感觉），结果将 确定对BCI-FES背驮疗法的应答性的特征（目的2）。最后，底层 驱动BCI-FES的神经改善的机制将使用明确的计算 中风恢复的神经科学模型，由实验神经生理学测量提供信息（目标3）。 确定BCI-FES治疗可以提供超出常规治疗的改善可能导致 一种新的神经修复机制，可以有效地治疗中风患者。这种机制可以告知设计 未来的物理治疗技术或改进现有的技术。最后，BCI-FES疗法可能最终成为一种 新形式的物理治疗，以减少中风后残疾，从而减少中风的公共卫生负担。

Project Summary There are over 7 million stroke survivors in the US alone, with approximately 795,000 new cases annually. Despite the best available physiotherapy, 30-60% of stroke survivors remain affected by gait function impairments, with foot drop often being the primary cause. Given that post-stroke gait impairments remain suboptimally addressed, novel methods that can provide lasting neurological and functional improvements are necessary. Brain-computer interface (BCI) technology may be one such novel approach. BCI technology enables “direct brain control” of external devices such as assistive devices and prostheses by translating brain electrophysiologi- cal signals (e.g. EEG) into control signals. When BCI systems are integrated with functional electrical stimulation (FES) systems, they can be used to deliver a novel physiotherapy to improve motor function after stroke. BCI- FES systems are hypothesized to stimulate a Hebbian plasticity process (where “neurons that fire together, wire together”), and this approach may lead to functional recovery after stroke beyond that of conventional physiother- apy. The applicant's preliminary research indicates that applying this technique to foot drop after stroke is safe and may improve gait function via neural processes. Hence, this warrants further investigation to: 1. determine if BCI-FES therapy can provide lasting gains in gait function in chronic stroke patients with foot drop; 2. determine what factors influence BCI-FES therapy; and 3. explicitly elucidate the underlying neural repair mechanisms. First, a Phase II clinical trial in patients with foot drop due to chronic stroke will compare the effect of BCI- FES dorsiflexion therapy to that of dose- and intensity-matched standard physiotherapy (Aim 1). Comparing the improvement in gait velocity and other secondary outcome measures between the two groups will test the hypothesis that BCI-FES therapy provides functional and neurological gains beyond those of conventional phys- iotherapy. It will also determine which aspects of gait impairment are best addressed with BCI-FES therapy versus conventional physiotherapy. The relationship between the subjects' baseline characteristics (gait velocity, dorsiflexion function, motor evoked potentials, electroencephalogram features, sensation) and the outcomes will determine what features influence responsiveness to BCI-FES dorsiflexion therapy (Aim 2). Finally, the underlying mechanism driving the neurological improvements of BCI-FES will be elucidated using an explicit computational neuroscience model of stroke recovery, informed by experimental neurophysiological measurements (Aim 3). Determining that BCI-FES therapy can provide improvements beyond that of conventional therapy may lead to a new neural repair mechanism that can be effective in stroke patients. This mechanism can inform the design of future physiotherapy techniques or improve current ones. Finally, BCI-FES therapy may ultimately become a novel form of physiotherapy to reduce post-stroke disability, and in turn reduce the public health burden of stroke.