Novel training environment to normalize altered finger force direction post stroke

新颖的训练环境可以使中风后改变的手指力方向正常化

• 批准号: 10806922
• 负责人: Na Jin Seo
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10806922
• 关键词: 3-Dimensional; Action Research; Activities of Daily Living; Acute; Address; Affect; Behavioral; Bilateral; Biomechanics; Caring; Cellular Phone; Clinic; Clinical; Computers; Control Groups; Custom; Data; Digit structure; Elbow; Environment; Equation; Evaluation; Failure; Feedback; Fingers; Forearm; Generations; Hand; Hand functions; Impairment; Intervention; Interview; Leisures; Lifting; Linear Models; Literature; Measures; Modality; Modeling; Motor; Movement; Muscle; Outcome; Outcome Measure; Palpable; Paresis; Patient-Focused Outcomes; Patients; Pattern; Performance; Posture; Pronation; Quality of life; Rehabilitation therapy; Research; Self Care; Shoulder; Side; Stroke; Structure; Testing; Thumb structure; Time; Training; Upper Extremity; Veterans; Walking; Work; arm; cost estimate; disability; experimental group; finger movement; follow-up; force sensor; grasp; hand dysfunction; hand rehabilitation; improved; inpatient service; learning strategy; motor control; motor learning; movement practice; neuroregulation; novel; post stroke; recruit; rehabilitative care; sensory feedback; stroke survivor; synergism; tool; trend

Estimated 15,000 Veterans suffer a stroke each year. Stroke is a leading cause of long-term disability in the US. New strokes cost an estimated $111 million for acute inpatient care, $75 million for post-acute inpatient care, and $88 million for follow-up care in the first six months post-stroke in VHA. Yet, more than two thirds of stroke survivors have persistent hand impairment that significantly diminishes their abilities to perform activities of daily living. Dexterous manipulation of objects, such as tools, dishes, and smart phones, require not only proper hand movement, but also proper force control. Not only movement, but also control of forces from fingers has been shown to be profoundly impaired following stroke, resulting in the object being mishandled, or not handled at all, and failure at task execution. Motor control literature shows that finger movement and force control involve two independent neural controls, and therefore must be independently rehabilitated. However, conventional upper extremity therapy focuses on movement control exclusively and does not address hand force control. This gap in treatment is due to a lack of tools to provide explicit feedback on patients’ volitional finger force control. To address this gap, a novel force training tool has been developed. This tool enables stroke survivors to practice volitional finger force generation in three-dimension (3D) with explicit feedback on directional control, per best known clinical motor learning strategy. Preliminary testing of this 3D force training showed significant improvement in hand function (assessed by the Action Research Arm and Box and Block Tests, ARAT and BBT) in stroke survivors with severe hand impairment. The objective of this project is to determine if 3D finger force training is an effective tool in restoring hand function post stroke. Sixty Veterans with stroke with moderate to severe hand impairment with palpable volitional grip force will be randomly be assigned to either the experimental or control group, stratified by impairment level. Both groups will undergo 3 1-hr training sessions per week for 6 weeks. The experimental group will receive explicit feedback in 3D force, whereas the control group will receive feedback in 1D only on a computer screen. This control condition is analogous to simple squeeze ball repetitions. Training will progress by increasing influence of flexion synergy by varying posture requirements and increasing force level, introducing feedback delay, and incorporating unilateral/bilateral activity. Evaluation will occur at baseline, every 2 weeks during 6-week intervention, and at 1-month follow-up. Aim 1: Determine the effect of 3D finger force training on behavioral hand function. Hypothesis: Hand function will improve more in the experimental group than the control group. Hand function will be assessed using ARAT, BBT, and Stroke Impact Scale. Meaningfulness of the intervention will be assessed via qualitative interviews. Aim 2: Determine the effect of 3D finger force training on finger force direction control. Hypothesis: The experimental group will achieve greater ability to direct finger force than control after the training. The ability to direct finger force will be quantified as angular deviation of volitional finger force from the target direction. Aim 3: Determine the biomechanical mechanisms underlying improvement in force direction control. Hypothesis: The training results in improved muscular coordination. Improved muscular coordination will be assessed by expansion of the attainable muscle activation patterns, increased motor complexity, similarity between the paretic vs. nonparetic synergy structures, and reduced abnormal flexion synergy during reach/grasp/transport/release. Hand-arm coordination will also be assessed. A custom OpenSim finger model will be used to explain the direct biomechanical mechanism by which changes in muscular coordination leads to enhanced finger force direction. Impact: This research will provide a treatment for force control, thereby addressing the unmet need in the current rehabilitation exclusively focused on movement practice. This research will also determine the underlying biomechanical mechanisms as well as the training’s impact on functional use of the hand. As a result, this research is expected to enhance hand function, thus increasing independence and quality of life for Veterans with stroke.

据估计，每年有15,000名退伍军人中风。在美国，中风是导致长期残疾的主要原因。 据估计，新中风的急性住院治疗费用为1.11亿美元，急性后住院治疗费用为7500万美元， 以及8800万美元用于VHA中风后前六个月的后续护理。然而，超过三分之二的中风患者 幸存者有持续性的手损伤，显著降低了他们执行日常活动的能力 活着。要熟练地操作工具、餐具和智能手机等物品，不仅需要正确的手 运动，但也要适当的力量控制。不仅是运动，而且对手指力量的控制也是如此 表现为中风后严重受损，导致对象处理不当，或根本不处理， 以及任务执行失败。运动控制文献表明，手指运动和力控制涉及两个方面 独立的神经控制，因此必须独立康复。然而，传统的鞋面 四肢疗法专注于运动控制，而不是手力控制。这一差距 在治疗中是由于缺乏工具来提供明确的反馈，以患者的意志指力控制。至 为了弥补这一差距，开发了一种新的部队训练工具。这一工具使中风幸存者能够练习 在具有关于方向控制的显式反馈的三维(3D)中生成意志力 已知的临床运动学习策略。这次3D部队训练的初步测试显示 手功能的改善(通过行动研究ARM、BOX和BLOCK测试、ARAT和BBT进行评估) 在有严重手损伤的中风幸存者中。该项目的目标是确定3D指力是否 训练是恢复中风后手功能的有效手段。60名退伍军人中风，中度至 有明显意志力握力的严重手损伤将随机分配给实验对象 或对照组，按损害程度分层。两组都将接受为期6周的每周3次1小时的训练。 实验组会收到三维力的显式反馈，而对照组会收到三维力的反馈 1D仅在计算机屏幕上显示。这种控制条件类似于简单的挤压球重复。培训将会 通过改变姿势要求和增加力量水平来增加屈曲协同的影响， 引入反馈延迟，并纳入单边/双边活动。评估将在基线上进行，每隔2 在为期6周的干预中和在1个月的随访中。目的1：确定3D指力训练的效果 关于手的行为功能。假设：实验组的手功能改善程度高于对照组。 一群人。手功能将使用ARAT、BBT和卒中影响量表进行评估。干预的意义 将通过定性访谈进行评估。目的2：确定3D指力训练对指力的影响 方向控制。假设：与对照组相比，实验组将获得更大的指力定向能力 训练结束后。直接指力的能力将被量化为意志指力与 目标方向。目标3：确定力量方向改善背后的生物力学机制 控制力。假设：训练可以改善肌肉的协调性。肌肉协调性的改善将是 通过可获得的肌肉激活模式的扩展、运动复杂性的增加、 偏瘫与非偏瘫的协同结构，并减少异常的屈曲协同 达到/抓住/运输/释放。还将评估手部和手臂的协调能力。定制的OpenSim Finger模型将是 用于解释肌肉协调性改变导致增强的直接生物力学机制 指力方向。影响：这项研究将为武力控制提供一种治疗方法，从而解决未满足的问题 目前康复的需要完全集中在动作练习上。这项研究还将确定 潜在的生物力学机制以及训练对手功能使用的影响。结果, 这项研究有望增强手的功能，从而提高退伍军人的独立性和生活质量 中风。