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，我们的退伍军人人群中风的发病率很高， 2014年，每年约有6,000例VA因急性缺血性卒中入院。康复计划， 改善上肢功能有可能影响退伍军人的日常生活活动， 职业、娱乐和整体生活质量。重复任务训练（RTT）是一种针对特定任务的积极实践。 运动活动，比简单的关节运动更有效地改善上肢功能， 治疗然而，RTT可能会对临床医生和患者造成消耗，因为它要求参与者 完成相同任务的多次重复，并且这些重复可能难以通过适当的 法先前的研究表明，要显著影响患者的恢复，在患者接受RTT治疗时启动RTT至关重要。 急性和亚急性阶段，保持健康关节协调，并保持患者参与和挑战。 机器人介导的RTT有可能促进临床交付的证明康复计划，我们的 退伍军人在需要和最近一个新的外骨骼已经开发出来，称为和谐，与能力，提供 双手3D手臂治疗。目前缺乏在恢复早期阶段提供RTT的工具， 在3D手臂运动期间保持关节协调，并确保与患者相称的辅助 能力.因此，本项目的目标是开发新的控制器，使用有前途的神经基础 进行训练，以促进重复性任务训练，同时确保急性和亚急性 中风病人分期具体地，（1）协同避免（SA）控制器将施加关节扭矩以推动关节。 患者远离不适应的关节协调，只干扰一旦受试者的运动 引发了这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 扭矩，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/届会）。目标1：开发并确定RTT控制器的可行性。H1：SA和TA控制器 可行，如（1）患者安全性和（2）TA和SA控制器移动上身关节沿着的能力所示 任务轨迹和远离协同协调。多达五名亚急性中风幸存者将 完成与SA和TA控制器的RTT活动。如果施加的扭矩 满足控制律定义的要求，并且满足TA和SA控制器的可行性准则 两个连续的病人。目标2：确定控制器的可行性并量化联合协调的变化 在为期三周的干预中。H2a：如（1）所示，使用两种控制器进行为期3周的干预是可行的 患者安全和（2）TA和SA控制器将上身关节向所需方向移动的能力 3D RTT活动的轨迹，同时避免协同补偿协调。H2B：机器人系统 将准确地跟踪急性中风患者在3周干预前后的关节协同作用， 补偿策略的变化。将招募两名急性卒中幸存者。参与者将被分配到 无论是TA或SA控制器，并将完成高重复达到任务，每天一次，而穿着 和谐外骨骼三周。关节运动学和动力学数据将由机器人系统记录， 所有的会议。运动学数据也将记录在评估会议之前和之后的3周 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。联合 将在三周干预前后对两名急性中风患者进行协同作用评估。 如果运动学之间的误差率可接受地低，则认为假设得到支持。 机器人系统和运动捕捉系统的测量。改善的新康复计划 上肢功能表现有可能影响退伍军人的ADL并改善其职业， 娱乐和整体生活质量。新的康复计划，改善上肢功能， 潜在的影响退伍军人的日常生活能力和改善他们的职业，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.