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

中风是导致严重残疾的最大原因。这种残疾最常见的原因是坚持不懈 手臂损伤。手臂损伤的很大一部分不是由虚弱或 痉挛，但由手臂肌肉之间异常的协同激活引起。这种协调功能障碍是 在最严重受损的患者中普遍存在，他们最需要新的治疗方法。至 为了治疗异常的肌肉协同激活，我们开发了一种肌电-计算机接口(MyoElectro-Computer Interfaction，MyoCI)。在……里面 此外，我们率先使用靶向记忆再激活(TMR)来增强记忆 在睡眠中巩固。这项研究的长期目标是开发一种负担得起的、非 具有侵入性且易于使用的MyoCI和TMR组合，可改善对ARM的控制 通过减少不正常的共激活来减少运动。我们的初步研究表明，TMR 在一组健康个体的单次午睡中加强MyoCI学习的巩固，以及 在三个中风幸存者中度过了几个晚上。因此，我们建议确定是否 这种训练加睡眠的组合将在更长的时间内普遍改善运动功能 卒中幸存者的训练方案。这项提案的目标是1)确定是否 TMR可以增强中风后的运动学习，2)确定最佳参数 MyoCI TMR范例以增强中风幸存者的运动功能。我们的中心假设是 用TMR补充MyoCI训练将显著增强学习，从而 改善手臂的运动。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在多大程度上促进了中风后MyoCI的学习，2)评估 在所有睡眠阶段进行TMR以增强中风后MyoCI的学习，以及3)评估 TMR剂量和卒中部位对MyoCI学习的影响这个建议很有新意 可穿戴、廉价和非侵入性MyoCI TMR的组合将使我们能够测试 TMR对卒中后运动学习的影响。实现我们的目标将是意义重大的 因为这将有助于发展一种强化的康复疗法，以改善 中风后的功能，可以广泛使用，可以帮助最严重的中风 幸存者。我们预计，鉴于其新颖性，该范例将与其他疗法协同作用。 作用机制(使用肌电信号减少共激活)。这项研究还将 提供有关大脑中哪些区域对巩固运动学习至关重要的基本信息。 我们还期望TMR可以应用于其他类型的中风康复 MyoCI。最后，该项目将提供规划更大规模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.