Customizable cooperative multi-joint control to enhance walking mobility after stroke

可定制的协作多关节控制，增强中风后的行走灵活性

• 批准号: 10444685
• 负责人: Nathaniel Steven Makowski
• 金额: $ 62.92万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444685
• 关键词: Activities of Daily Living; Address; Adopted; Ankle; Bypass; Case Series; Case Study; Cervical; Clinical; Clinical Trials; Cognitive; Communities; Contracts; Data; Development; Devices; Effectiveness; Environment; Fiber; Future; Gait; Goals; Health; Hip region structure; Home; Impairment; Implant; Individual; Intervention; Intuition; Joints; Knee; Laboratories; Lead; Leg; Length; Life; Limb structure; Lower Extremity; Machine Learning; Measures; Methods; Motion; Movement; Multiple Sclerosis; Muscle; Nerve; Orthotic Devices; Paresis; Participant; Pattern; Persons; Physical therapy; Physiologic pulse; Pilot Projects; Preparation; Prosthesis; Protocols documentation; Quality of life; Rehabilitation therapy; Residual state; Safety; Scheme; Self-Help Devices; Sensory; Side; Signal Transduction; Speed; Spinal cord injury; Surface; System; Techniques; Technology; Therapeutic; Thigh structure; Time; Training; Upper Extremity; Volition; Walking; Weight; Work; base; cardiovascular health; clinical implementation; community setting; design; exoskeleton; fall risk; falls; follow-up; foot; functional independence; hand dysfunction; implanted sensor; improved; improved functioning; improved mobility; innovation; neuroprosthesis; noninvasive brain stimulation; operation; post stroke; sedentary lifestyle; sensor; social; stroke survivor; tool; treadmill; walking speed

Most stroke survivors walk slowly and are at an increased risk of falls. As a result, many adopt a sedentary lifestyle with limited functional independence that negatively impacts health and can be socially isolating. Physical therapy including advanced rehabilitation techniques have improved function, but there is no intervention available that enables stroke survivors with moderate and severe impairment to walk at speeds necessary for independent community ambulation. The long-term goal of this work is to restore stroke survivors’ ability to walk safely in the community at speeds necessary for independence. Our approach utilizes an implanted neuroprosthesis, that is a device inside the body that applies small electrical pulses to activate the nerves that cause the muscles serving multiple joints to contract in a coordinated manner for functional movement of the entire limb. The system measures volitional muscle activity and body motion and then coordinates stimulation at the different joints in the leg to produce the necessary movement for safe walking at functionally relevant speeds. The benefit of such an approach is that it is always available and does not require setup for individuals with impaired hand control. The implanted hardware also improves reliability and bypasses sensory fibers that can cause discomfort. Our team has shown in a case study that targeting muscles throughout the paretic limb can substantially improve walking speed and endurance. This study will expand this work through achieving the following Aims: 1) determining the clinical impact of an implanted multi- joint neuroprosthesis on post-stroke gait, and 2) developing and assessing an advanced neuroprosthesis cooperative control strategy. This study will implement an available neuroprosthesis that incorporates an external control unit and some external sensors in preparation for implementation of a fully implanted system that has been developed at our Center. Six participants will be implanted with devices that include 12-channels of stimulation and 2-channels for recording muscle activity. External sensors will measure limb motion. After the device is implanted, stimulation patterns will be generated and participants will undergo training to use the device. A simple triggering pattern will be created for home use and then we will implement our advanced controller in the laboratory via machine-learning techniques. Once a controller and stimulation pattern have been defined, we will determine how much faster, more safely, and easier walking is with the neuroprosthesis compared to without and confirm whether these effects are maintained over time. We will also determine if the advanced controller substantially improves walking ability over the simple triggering methods that have been previously implemented. Successful completion will confirm approaches for a post-stroke neuroprosthesis for walking and generate preliminary effect sizes for subsequent clinical trials to evaluate home and community use of a fully implanted system. This study may lead to a new clinical tool that can empower independent walking after stroke, improve quality of life, and enhance overall health of stroke survivors.

大多数中风幸存者走路缓慢，福尔斯的风险增加。因此，许多人采用 久坐不动的生活方式，功能独立性有限，对健康产生负面影响，并可能在社交上 孤立包括先进康复技术在内的物理治疗改善了功能，但没有 提供干预措施，使中度和重度损伤的中风幸存者能够快速行走 这是独立社区自治的必要条件。这项工作的长期目标是恢复中风 幸存者在社区中以独立所需的速度安全行走的能力。我们的方法利用 一种植入的神经假体，这是一种在体内应用小电脉冲来激活 使多个关节的肌肉以协调的方式收缩以实现功能的神经 整个肢体的运动。该系统测量意志肌肉活动和身体运动， 协调腿部不同关节处的刺激，以产生安全行走所需的运动， 功能相关的速度。这种方法的好处是它总是可用的，并且不需要 为手部控制能力受损的人设置。植入的硬件还提高了可靠性， 绕过了会引起不适的感觉纤维我们的团队在一个案例研究中表明， 整个瘫痪肢体的肌肉可以显著提高步行速度和耐力。本研究将 通过实现以下目标来扩展这项工作：1）确定植入的多- 关节神经假体对中风后步态的影响，以及2）开发和评估先进的神经假体 协同控制策略本研究将实施一种可用的神经假体， 准备实施完全植入系统的外部控制单元和一些外部传感器 这是在我们中心开发的。六名参与者将植入包括12个通道的设备 的刺激和2通道记录肌肉活动。外部传感器将测量肢体运动。后 植入器械后，将生成刺激模式，参与者将接受使用器械的培训。 设备.一个简单的触发模式将被创建为家庭使用，然后我们将实现我们的先进的 通过机器学习技术在实验室中实现控制器。一旦控制器和刺激模式具有 我们将确定使用神经假体行走有多快、多安全、多容易 并确认这些效果是否随着时间的推移而保持。我们还将确定 先进的控制器大大提高了步行能力的简单触发方法， 以前实施的。成功完成将确定中风后神经假体的方法， 步行，并为随后的临床试验产生初步的效应量，以评估家庭和社区 使用完全植入的系统。这项研究可能会产生一种新的临床工具， 中风后步行，改善生活质量，提高中风幸存者的整体健康。