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，并且退伍军人中中风的发病率很高 2014 年，退伍军人管理局每年约有 6,000 名患者因急性缺血性中风入院。 改善上肢功能有可能影响退伍军人的日常生活活动并改善他们的 职业、娱乐和整体生活质量。重复任务训练（RTT）是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术后上肢功能 治疗。然而，RTT 可能会让临床医生和患者都精疲力尽，因为它要求参与者 完成同一任务的多次重复，而这些重复可能很难通过适当的方法来完成 技术。先前的研究表明，为了显着影响患者的康复，在以下情况下启动 RTT 至关重要： 急性和亚急性阶段，保持健康关节协调性，让患者保持参与和挑战。 机器人介导的 RTT 有潜力促进将经过验证的康复计划临床交付给我们 退伍军人有需要，最近开发了一种新的外骨骼，称为 Harmony，能够提供 双手 3D 手臂治疗。目前缺乏在恢复早期阶段提供 RTT 的工具，而 在 3D 手臂运动期间保持关节协调，并确保援助与患者相称 能力。因此，该项目的目标是开发利用有前途的神经学基础的新型控制器 用于培训以促进重复性任务训练，同时确保急性和亚急性的正确运动模式 阶段性中风患者。具体来说，（1）协同避免（SA）控制器将施加关节扭矩来推动 患者远离适应不良的关节协调，仅在受试者运动时干扰 发起了这样一种适应不良的运动策略。 (2) 任务辅助（TA）控制器将应用辅助关节 扭矩可直接帮助中风患者实现高强度正确协调的 3D RTT 活动 （重复/会话）。目标 1：开发并确定 RTT 控制器的可行性。 H1：SA 和 TA 控制器是 可行，如 (1) 患者安全和 (2) TA 和 SA 控制器移动上半身关节的能力 分别是任务轨迹和远离协同协调。多达五名亚急性中风幸存者将 与 SA 和 TA 控制器一起完成 RTT 活动。如果施加的扭矩，H1 将被视为受支撑 满足控制法定义的要求，并且满足 TA 和 SA 控制器的可行性标准 在两个连续的患者中。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 3 周的干预期间。 H2a：对于两个控制者来说，为期 3 周的干预是可行的，如 (1) 所示 患者安全以及 (2) TA 和 SA 控制器将上半身关节移向所需位置的能力 3D RTT 活动的轨迹，同时避免协同补偿协调。 H2b：机器人系统 将准确跟踪急性中风患者在为期 3 周的干预前后的关节协同作用，揭示任何 补偿策略的改变。将招募两名急性中风幸存者。参与者将被分配到 TA 或 SA 控制器，并且将在佩戴 TA 或 SA 控制器的情况下每天完成一次高度重复的到达任务 Harmony 外骨骼为期三周。机器人系统将记录关节运动学和动力学数据 所有会议。运动数据也将记录在为期 3 周前后的评估会议中 干预有两种方式：机器人处于零扭矩模式和使用红外运动跟踪系统。联合 将评估两名急性中风患者在为期三周的干预前后的协同作用。 如果运动学之间存在可接受的低误差率，则假设将被视为得到支持。 机器人系统和动作捕捉系统的测量。新的康复计划可改善 上肢功能表现有可能影响退伍军人的 ADL 并改善他们的职业， 娱乐和整体生活质量。改善上肢功能的新康复计划具有 影响退伍军人日常生活能力并改善他们的职业、娱乐和整体生活质量的潜力。

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.