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75%以上的人患有持续性手 即使在完全康复之后，他们的独立性也会大大降低。 从根本上说，中风后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有希望。不幸的是，改变的肌肉激活模式 在目前的康复中得到充分解决。以前的努力仅限于训练一对肌肉， 未能解决异常的节段间偶联。为了解决这一差距，一种新颖的肌电控制的游戏系统， 已经开发了：肌电信号被映射到计算机屏幕上光标的二维运动 玩游戏在一项初步研究中，目标肌电图模式来自4个非麻痹远端上 肢体肌肉肌电图，而游戏使用4个轻瘫远端上肢肌肉肌电图映射到 目标模式，从而促进在轻瘫肢体中使用非轻瘫肌肉激活模式。二十 脑卒中幸存者通过Wolf运动功能测试功能能力评估上肢功能改善 (WMFT在9场比赛之后，FA）显着。目的：扩大肌电控制系统的容量 游戏系统，并将其整合到一个完整的治疗模式。目标1：完善制度。肌肉激活 模式将以非负EMG幅度为特征，以使游戏控制更直观。的 EMG输入通道的数量将增加，以包括近端和远端上肢肌肉， 节间训练更多的游戏将被创造出来。改进系统的可行性将是 与神经系统完好的退伍军人进行评估。目标2-3将在退伍军人卒中幸存者中评价该系统。 退伍军人中风幸存者将被随机分配到两组之一。治疗组将接受9 EMG游戏课程和9个任务练习治疗课程交替进行。对照组将 接受18次任务练习治疗。将在基线、术后和1个月随访时进行评价。目的 2：确定EMG游戏系统加任务练习疗法对上肢功能的影响。假设： 采用肌电图游戏结合任务练习疗法的团体训练，可改善上肢功能 WMFT FA（初级）评估的功能比剂量匹配的任务练习治疗组更好 只.目的3：确定与EMG控制游戏训练相关的神经力学变化。 假设：仅在治疗时，轻瘫肌肉激活模式将同化为非轻瘫模式 组相似性将通过计算由麻痹EMG定义的超平面之间的角度来量化 模式和由非麻痹性EMG模式定义的平面。影响：这项研究将解决目前 通过开发/评估一种新型的EMG控制游戏系统来训练肌肉激活模式， 从而直接解决中风后运动损伤的起源。这项研究有望提高上 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.