Developing and Determining Feasibility of a Novel Upper Extremity Robotic Exoskeleton to Track and Target Unwanted Joint Synergies during Repetitive Task Training in Stroke Survivors

中风会导致严重的长期残疾，在我们的退伍军人中，中风的发病率很高 2014年，每年约有6,000名退伍军人管理局因急性缺血性中风入院。康复计划 改善上肢功能有可能影响退伍军人的日常生活能力，改善他们的 度假、娱乐和整体生活质量。重复性任务训练是对特定任务的积极练习 运动功能较单纯关节活动改善上肢功能更有效。 治疗。然而，RTT可能会对临床医生和患者造成引流，因为它要求参与者 完成同一任务的许多重复，而这些重复可能很难通过适当的方式完成 技术。先前的研究表明，要显著影响患者的康复，在 在急性期和亚急性期，保持健康的关节协调，保持患者的投入和挑战。 机器人介导的RTT有可能促进临床上向我们的 需要的退伍军人和最近开发的一种新的外骨骼，称为和谐，具有交付的能力 双指甲3D手臂疗法。目前，在恢复的早期阶段缺乏交付RTT的工具，而 在3D手臂移动过程中保持关节协调，并确保辅助与患者相称 超能力。因此，该项目的目标是开发使用前景广阔的神经学基础的新型控制器 用于训练，以促进重复性任务训练，同时确保急性和亚急性时正确的运动模式 晚期中风患者。具体地说，(1)协同避让(SA)控制器将应用关节力矩来推动 患者远离关节协调性不适应，只干扰受试者一次动作 发起了这样一种不适应的运动策略。(2)任务辅助(TA)控制器将应用辅助关节 力矩直接帮助中风患者在高强度下实现正确协调的3D RTT活动 (重复次数/会议)。目的1：研制RTT控制器并确定其可行性。H1：SA和TA控制器为 从(1)患者安全和(2)TA和SA控制器沿上半身关节移动的能力来看，这是可行的 任务轨迹和远离协同协调。至多5名亚急性中风幸存者将 与SA和TA控制员一起完成RTT活动。如果施加的扭矩为H1，则认为H1受支持 满足控制律定义的要求，并满足TA和SA控制器的可行性标准 在连续两名患者中。目标2：确定控制员的可行性并量化联合协调中的变化 在为期3周的干预中。H2 A：如(1)所示，对两个控制器进行为期3周的干预是可行的 患者安全和(2)TA和SA控制器将上半身关节移动到所需位置的能力 3DRTT活动的轨迹，同时避免协同补偿协调。H_2B：机器人系统 将准确跟踪急性中风患者在3周干预前后的关节协同效应，揭示任何 补偿策略的变化。将招募两名急性中风幸存者。参与者将被分配到 无论是TA还是SA控制员，都将在佩戴 和谐外骨骼，为期三周。关节运动学和运动学数据将由机器人系统记录在#年 所有的课程。运动学数据也将记录在为期3周的评估会议之前和之后 在两种模式下进行干预：零扭矩模式下的机器人和使用红外运动跟踪系统。接合 在为期三周的干预前后，将对两名急性中风患者的协同作用进行评估。 如果运动学之间存在可接受的低误差率，则假设将被视为支持 机器人系统和运动捕捉系统的测量。新的康复计划改善了 上肢功能表现有可能影响退伍军人的日常生活能力，改善他们的职业生涯， 娱乐性和整体生活质量。改善上肢功能的新康复计划有 潜在地影响退伍军人的ADL，并改善他们的职业、娱乐和整体生活质量。

Stroke causes significant long-term disability and the incidence of stroke in our Veteran population is high with approximately 6,000 VA admissions for acute ischemic stroke per year in 2014. Rehabilitation programs that improve upper extremity function have the potential to impact Veterans’ activities of daily living and improve their vocation, recreation, and overall quality of life. Repetitive task training (RTT) is active practice of a task-specific motor activity and is more effective than simple joint movements in improving upper extremity function after treatment. However, RTT can be draining for both the clinician and the patient as it requires the participant to complete many repetitions of the same task and those repetitions can be difficult to accomplish with appropriate technique. Previous research has shown that to significantly affect patient recovery it is critical to initiate RTT in the acute and sub-acute stages, maintain health joint coordination, and keep the patients engaged and challenged. Robot-mediated RTT has the potential to facilitate the clinical delivery of proven rehabilitation programs to our Veterans in need and recently a new exoskeleton has been developed, called Harmony, with the ability to deliver bimanual 3D arm therapy. Currently there a lack of tools for delivering RTT in the early stages of recovery while maintaining joint coordination during 3D arm movement and ensuring that assistance commensurate with patient abilities. Therefore, the objective of this project is to develop novel controllers that use promising neurological basis for training to facilitate repetitive task training while ensuring correct movement patterns in acute and sub-acute stage stroke patients. Specifically, (1) synergy avoidance (SA) controller will apply joint torques to push the patients away from the maladaptive joint coordination, only interfering with the movements once the subject initiates such a maladaptive movement strategy. (2) Task assistance (TA) controller will apply assistive joint torques to directly help stroke patients achieve 3D RTT activities with correct coordination at a high intensity (repetitions/session). Aim 1: to develop and determine feasibility of RTT controller. H1: SA and TA controllers are feasible, as seen by (1) patient safety and (2) abilities of TA and SA controllers to move upper-body joints along task trajectories and away from synergistic coordination, respectively. Up to five sub-acute stroke survivors will complete RTT activities with both the SA and TA controllers. H1 will be considered supported if the applied torque meets the requirements defined by the control law and the feasibility criteria are met for the TA and SA controllers in two consecutive patients. Aim 2: determine feasibility of controllers and quantify change in joint coordination during 3-week intervention. H2a: a 3-week long intervention is feasible with both the controllers as seen by (1) patient safety and (2) abilities for TA and SA controllers to move the upper-body joints toward the desired trajectories for 3D RTT activities while avoiding synergistic compensatory coordination. H2b: the robotic system will accurately track joint synergies in acute stroke patients before and after a 3-week intervention, revealing any change in compensatory strategies. Two acute stroke survivors will be recruited. Participants will be assigned to either the TA or SA controller and will complete high repetitions of reaching tasks once per day while wearing the Harmony exoskeleton for three weeks. Joint kinematic and kinetic data will be recorded by the robotic system in all the sessions. Kinematic data will also be recorded in the evaluation sessions before and after the 3-week intervention in two modalities: robot in zero-torque mode and using an infrared motion tracking system. Joint synergies will be evaluated for the two acute stroke patients before and after a three-week intervention. Hypotheses will be considered supported if there is an acceptably low rate of error between the kinematic measurements of the robotic system and the motion capture system. New rehabilitation programs that improve upper extremity functional performance have the potential to impact Veterans’ ADL and improve their vocation, recreation, and overall quality of life. New rehabilitation programs that improve upper extremity function have the potential to impact Veterans’ ADLs and improve their vocation, recreation, and overall quality of life.