EMG-Controlled Game to Retrain Upper Extremity Muscle Activation Patterns Following Stroke

据估计，每年有15,000名退伍军人中风，其中超过75%的人有持续性手 即使在进行了显著削弱其独立性的完整康复疗程后，他们的身体也会受到损害。 从根本上说，中风后的上肢损伤是由肌肉激活模式的改变引起的。因此，直接 肌肉激活模式的训练很有希望。不幸的是，改变的肌肉激活模式并不是 在当前的康复中得到了充分的解决。以前的努力仅限于训练一对肌肉， 未能解决节段间的异常连接问题。为了弥补这一差距，一种新型的肌电控制的游戏系统 已经开发出：肌电信号被映射到计算机屏幕上光标的二维运动 来玩游戏。在一项初步研究中，目标肌电模式来自4个非偏瘫的上肢远端。 肢体肌肉肌电，而游戏使用4个偏瘫上肢远端肌肉肌电映射到 靶模式，从而促进非瘫痪肌肉激活模式在瘫痪肢体中的使用。二十 Wolf运动功能测试评定卒中幸存者上肢功能改善 (WMFT FA)在9场比赛后显著增加。目的：扩大肌电控制仪的容量 游戏系统，并将其整合到一个完整的治疗范例中。目标一：完善制度。肌肉激活 图案将以非负的肌电幅度为特征，使游戏控制更加直观。这个 将增加肌电输入通道的数量，以包括上肢近端和远端肌肉，以 分段间歇训练。将为参与创建更多的游戏。改进后的系统的可行性将是 由神经学上完好无损的退伍军人评估。AIMS 2-3将与经验丰富的中风幸存者一起评估该系统。 退伍军人中风幸存者将被随机分配到两组中的一组。治疗组将收到9 EMG游戏疗程和9个任务练习疗法疗程交替进行。对照组将 接受18次任务练习治疗。评估将在基线、后和1个月的随访中进行。目标 2：确定肌电游戏系统加任务练习疗法对上肢功能的影响。假设： 小组训练配合肌电游戏结合任务练习疗法将改善他们的上肢 WMFT FA(初级)评估的功能多于剂量匹配任务练习疗法的小组训练 只有这样。目的3：确定与肌电控制游戏训练相关的神经力学变化。 假设：偏瘫肌肉激活模式仅在治疗过程中才会与非偏瘫模式同化。 一群人。相似性将通过计算由偏瘫肌电定义的超平面之间的角度来量化 模式和由非偏瘫肌电模式定义的平面。影响：这项研究将解决当前 治疗差距通过开发/评估一种新的肌电控制的游戏系统来训练肌肉激活模式， 从而直接解决中风后运动障碍的根源。这项研究有望加强 肢体康复结果，有助于改善中风退伍军人的独立性和生活质量。

An estimated 15,000 Veterans suffer a stroke per year, more than 75% of whom have persistent hand impairment even after a full course of rehabilitation that significantly diminishes their independence. Fundamentally, post-stroke upper limb impairments arise from altered muscle activation patterns. Thus, direct training of muscle activation patterns holds promise. Unfortunately, altered muscle activation patterns are not fully addressed in current rehabilitation. Previous efforts have been limited to training a single pair of muscles, failing to address aberrant intersegmental coupling. To address this gap, a novel EMG-controlled game system has been developed: EMG signals are mapped to the 2-dimensional motion of a cursor on a computer screen to play games. In a preliminary study, the target EMG patterns were derived from 4 nonparetic distal upper limb muscle EMGs, while games were played using 4 paretic distal upper limb muscle EMGs mapped to the target patterns, thereby promoting use of the nonparetic muscle activation patterns in the paretic limb. Twenty stroke survivors improved upper limb function assessed by the Wolf Motor Function Test Functional Abilities (WMFT FA) significantly after 9 game sessions. Objective: To expand the capacity of the EMG-controlled game system and integrate it into a full therapy paradigm. Aim 1: Improve the system. Muscle activation patterns will be characterized with nonnegative EMG amplitudes to make the game control more intuitive. The number of EMG input channels will be increased to include both proximal and distal upper limb muscles for intersegmental training. More games will be created for engagement. Feasibility of the improved system will be evaluated with neurologically intact Veterans. Aims 2-3 will evaluate the system with Veteran stroke survivors. Veterans stroke survivors will be randomly assigned to one of two groups. The treatment group will receive 9 EMG game sessions and 9 task practice therapy sessions in an alternating order. The control group will receive 18 task practice therapy sessions. Evaluation will occur at baseline, post, and 1-month follow-up. Aim 2: Determine the effect of the EMG game system plus task practice therapy on upper limb function. Hypothesis: The group training with the EMG games in conjunction with task practice therapy will improve their upper limb function assessed by WMFT FA (primary) more than the group training with dose-matched task practice therapy only. Aim 3: Determine the neuromechanical changes associated with training with the EMG-controlled games. Hypothesis: The paretic muscle activation patterns will assimilate to the nonparetic pattern only for the treatment group. The similarity will be quantified by computing the angle between the hyperplane defined by the paretic EMG patterns and the plane defined by the nonparetic EMG patterns. Impact: This research will address the current treatment gap by developing/evaluating a novel EMG-controlled game system to train muscle activation patterns, thereby directly addressing the origin of post-stroke motor impairment. This research is expected to enhance upper limb rehabilitation outcomes, contributing to improved independence and quality of life for Veterans with stroke.