Stroke Rehabilitation utilizing BCI technology

摘要 在美国，每年有近80万人罹患新发或复发的中风。大约85% 这些患者存活下来并需要康复，使其成为导致长期残疾的主要原因 美国约有400万美国人生活在中风的影响下，数百万人 家人/朋友是照顾者。估计的中风直接和间接成本继续上升(例如 2003年为570亿美元，2008年为655亿美元，2010年估计为737亿美元)。中庸之道 在美国，缺血性中风的终生成本估计为140,048美元，包括住院护理、康复和 随访。中风的大部分费用用于长期护理和康复(&gt； 每名患者100,000美元)。中风后期的康复是有限的，因为大多数医疗保健 保险只为有限的康复就诊支付费用(12-24次门诊康复就诊)。然而，还有空间 在降低这些卒中的发病率和提高功能独立性方面的改善 患者，因为三分之一的患者有某种类型的残存缺陷。 尽管已经有几种旨在恢复中风的康复技术，包括 传统的物理-职业-言语疗法，如强迫诱导运动等新疗法 治疗、机器人辅助治疗、经颅磁刺激(TMS)、虚拟现实(VR)、许多 这些问题包括被动运动重复、大型设备、人员/时间限制， 而且成本很高。此外，很少有人利用大脑的可塑性来得出治疗干预措施。 由美国国立卫生研究院神经科学蓝图赞助的2009年研讨会的建议 研究表明，神经可塑性的转化是制定有效临床指南的关键 康复中的治疗。 目的1：比较BCI-FES与标准FES(现行护理标准)的疗效。 通过中风患者行为测量的变化。 最近的一个发展是使用了更积极的康复方法，利用 基于脑电的脑机接口(BCI)系统推断的大脑思维的大脑可塑性 与肌肉的功能性电刺激(FES)相联系，以取代或辅助丧失的功能 神经学受损的人。在最近的动物和人类研究中，主动刺激 协调中央大脑的激活和外周运动已被证明能引起更大的功能 恢复比被动刺激或外周运动要好。这大概是通过更快的 在中枢和外周之间形成潜在的可塑性神经回路，这是一种积极的方法 福斯特。该提案研究了这种采用主动干预方法的新型BCI技术， 无创，旨在通过在改善的同时恢复脑功能来促进脑损伤后的恢复 相应的运动功能。 目标2和3：跟踪BCI-FES与BCI-FES引起的脑重组变化和行为变化。 中风患者的标准FES(目前的护理标准)。 我们还建议使用这种方法研究潜在的功能恢复机制，方法是 收集不同时间点的fMRI、EEG和DTI，监测脑部变化的程度，并 勾勒出与行为改善相关的区域和区域。最新的研究 中风的康复表明，患侧和对侧区域和束起着重要作用 在恢复过程中的作用。这些区域和区域可能是适应性的，对恢复是必不可少的 而其他人可能不适应。未来使用这种新型中风康复设备的研究可以 旨在促进适应性区域/区域和抑制适应性不良区域/区域，以便优化 恢复。

ABSTRACT Each year nearly 800,000 people suffer a new or recurrent stroke in the United States. Approximately 85% of these patients survive and require rehabilitation making it the leading cause of long-term disability in the U.S. Approximately 4 million Americans are living with the effects of stroke and millions of family/friends are caregivers. The estimated direct and indirect costs of stroke continue to escalate (e.g. in 2003 was $57 billion, 2008 was $65.5 billion, and for 2010 is estimated to be $73.7 billion). The mean lifetime cost of ischemic stroke in the US is estimated at $140,048, including inpatient care, rehab, and follow-up care. The majority of stroke costs are towards long-term care and rehabilitation (> $100,000/patient). Stroke rehabilitation in the latter stages of stroke is limited because most health care insurance pays only for limited rehabilitation visits (12-24 outpatient rehabilitation visits). Yet there is room for improvement in terms of decreasing morbidity and improving functional independence in these stroke patients, given that 1/3 of patients have some type of residual deficits. Although there are already several rehabilitation techniques aimed at stroke recovery including traditional physical-occupational-speech therapy, novel therapies such as constraint-induced movement therapy, robot- aided therapy, Transcranial Magnetic Stimulation (TMS), virtual reality (VR), a number of these suffer from issues of passive movement repetition, large equipment, personnel/time constraints, and high costs. Furthermore few harness brain plasticity to derive therapeutic interventions. The recommendations from the 2009 workshop sponsored by the NIH blueprint for neuroscience research heralded the translation of neuroplasticity as key to developing guidelines for effective clinical therapies in rehabilitation. Aim 1: To investigate the efficacy of BCI-FES vs. standard FES(current standard of care), as measured by changes in behavioral measures in stroke patients. A more recent development has been the use of a more active rehabilitation approach that harnesses brain plasticity in which brain thoughts inferred by EEG-based Brain Computer Interface (BCI)system are linked to functional electrical stimulation (FES) of the muscles to replace or assist function that is lost in neurologically impaired individuals. In recent animal and human studies, active stimulation by coordinating central brain activation with peripheral movement has been shown to elicit greater functional recovery than passive stimulation or peripheral movements. This is presumably through the faster formation of latent plastic neural circuits between central and periphery which an active approach would foster. This proposal investigates this novel BCI technology that adopts an active intervention approach, non-invasive and aims to facilitate recovery after brain injury by restoring brain function while improving corresponding motor function. Aims 2 & 3: To track brain reorganization changes and behavioral changes induced by BCI-FES vs. standard FES (current standard of care) in stroke patients. We also propose to study the mechanisms underlying functional recovery using this approach by collecting fMRI, EEG and DTI at different time points so as to monitor the extent of brain changes and to delineate the areas and tracts that are associated with improvement in behavior. Recent studies of stroke rehabilitation have suggested that ipsilesional and contralesional areas and tracts play an important role in the recovery process. These areas and tracts may be adaptive and essential for recovery whereas others may be maladaptive. Future studies using the novel stroke rehabilitation device can be aimed at facilitating adaptive areas/tracts and suppressing maladaptive areas/tracts in order to optimize recovery.