Combining myoelectric training with sleep-based memory reactivation to improve motor recovery after stroke

中风是造成重大残疾的最大原因。这种残疾通常是由于持续的 手臂损伤很大一部分手臂损伤不是由虚弱或 痉挛，但手臂肌肉之间的异常共同激活。这种协调功能障碍是 在最需要新疗法的最严重受损患者中普遍存在。到 治疗异常肌肉共激活，我们开发了一个肌电计算机接口（MyoCI）。在 此外，我们率先使用目标记忆再激活（TMR）来增强记忆 睡眠中的巩固。这项研究的长期目标是开发一种负担得起的，非 有创且易于使用MyoCI和TMR组合，可改善手臂控制 运动通过减少异常的共同激活。我们的初步研究表明，TMR 在一组健康个体中，在单次小睡中增强MyoCI学习的巩固，以及 在三个中风幸存者身上进行了几个晚上的研究。因此，我们建议确定是否 这种训练加睡眠的组合将推广到改善运动功能，而不是延长 中风幸存者的训练方案本提案的目标是：（1）确定是否 TMR可以增强中风后的运动学习，以及2）确定用于TMR的最佳参数。 MyoCI+TMR范式增强卒中幸存者的运动功能。我们的核心假设是 用TMR补充MyoCI培训将大大增加学习， 改善手臂运动。我们将通过以下具体目标来检验这一假设：1）检验 SWS期间TMR增强卒中后MyoCI学习的程度，2）评估 在所有睡眠阶段进行TMR，以增强中风后的MyoCI学习，以及3）评估 TMR剂量和中风位置对MyoCI学习影响。这个提议很有创意 可穿戴、廉价和无创的MyoCI+TMR组合将使我们能够测试 TMR对脑卒中后运动学习的影响实现我们的目标将具有重大意义 因为它将促进增强康复治疗的发展， 脑卒中后的功能，可以广泛使用，并可以帮助最严重的受损中风 幸存者我们期望该范例将与其他疗法协同，因为其新颖性。 作用机制（使用肌电信号减少共激活）。该研究还将 提供关于哪些大脑区域对巩固运动学习至关重要的基本信息。 我们进一步期望，TMR可以应用于其他类型的中风康复，除了 Myoci。最后，该项目将提供计划大型临床试验所需的关键信息， 评估这种方法和相关方法的有效性。

Stroke is the largest cause of major disability. This disability most often results from persistent arm impairment. A significant portion of arm impairment is caused not by weakness or spasticity, but by abnormal co-activation among arm muscles. This coordination dysfunction is pervasive in the most severely impaired patients, who are most in need of new therapies. To treat abnormal muscle co-activation, we developed a myoelectric-computer interface (MyoCI). In addition, we pioneered the use of targeted memory reactivation (TMR) to enhance memory consolidation during sleep. The long-term goal of this research is to develop an affordable, non- invasive, and easy-to-use combination of MyoCI and TMR that improves control of arm movements by reducing abnormal co-activation. Our preliminary studies show that TMR enhances consolidation of MyoCI learning in a single nap in a group of healthy individuals, and across several nights in three stroke survivors. Accordingly, we propose to determine whether this training-plus-sleep combination will generalize to improve motor function over an extended training protocol in stroke survivors. The objectives of this proposal are 1) to determine whether TMR can augment motor learning after stroke, and 2) to determine optimal parameters for the MyoCI+TMR paradigm to enhance motor function in stroke survivors. Our central hypothesis is that supplementing MyoCI training with TMR will augment learning considerably and thereby improve arm movement. We will test this hypothesis via the following specific aims: 1) Test the extent to which TMR during SWS enhances MyoCI learning after stroke, 2) Assess the ability of TMR across all sleep stages to enhance MyoCI learning after stroke, and 3) Assess the influence of TMR dose and stroke location on MyoCI learning. This proposal’s innovative combination of wearable, inexpensive, and noninvasive MyoCI+TMR will enable us to test the effects of TMR on motor learning after stroke. Achieving our objectives will be significant because it will facilitate the development of an enhanced rehabilitative therapy to improve function after stroke that could be used widely and could help the most severely impaired stroke survivors. We expect that the paradigm will be synergistic with other therapies, given its novel mechanism of action (reducing co-activation using myoelectric signals). The research will also provide basic information about what brain areas are critical for consolidating motor learning. We further expect that TMR could be applied to other types of stroke rehabilitation in addition to MyoCI. Finally, this project will provide critical information needed to plan larger clinical trials to assess efficacy of this and related approaches.