Optimizing Hand Rehabilitation Post-Stroke Using Interactive Virtual Environments

使用交互式虚拟环境优化中风后手部康复

• 批准号: 9389860
• 负责人: SERGEI V ADAMOVICH
• 金额: $ 78.76万
• 依托单位: NEW JERSEY INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-05 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9389860
• 关键词: Acute; Affect; Algorithms; Animals; Articular Range of Motion; Behavioral; Biological Assay; Biological Markers; Brain; Caring; Chronic Phase; Clinical; Complex; Consensus; Data; Development; Dose; Early Intervention; Elements; Financial compensation; Fingers; Funding; Future; Hand; Hand functions; Hospitals; Hour; Human; Impairment; Individual; Inpatients; Intervention; Investigation; Kinetics; Knowledge; Legal patent; Length of Stay; Lesion; Limb structure; Literature; Maps; Measures; Modeling; Modification; Motion; Motor; Motor Evoked Potentials; Motor Skills; Movement; Muscle; Neuronal Plasticity; Outcome; Outcome Study; Outpatients; Patients; Pattern; Performance; Phase; Process; Randomized; Recovery; Recovery of Function; Rehabilitation therapy; Robot; Robotics; Services; Severities; Stroke; Structure; System; Testing; Therapeutic; Time; Training; Translating; United States; Upper Extremity; Variant; Work; arm; base; constraint induced movement therapy; design; dosage; experience; finger movement; functional gain; functional outcomes; grasp; hand rehabilitation; hand therapy; haptics; hemiparesis; improved; kinematics; motor control; motor impairment; motor recovery; neglect; neurophysiology; outcome forecast; outcome prediction; post stroke; robotic training; simulation; stroke intervention; stroke rehabilitation; treatment as usual; virtual reality; visual feedback

Project Abstract This application seeks funding to continue our on-going investigation into the effects of intensive, high dosage task and impairment based training of the hemiparetic hand, using haptic robots integrated with complex gaming and virtual reality simulations. A growing body of work suggests that there is a time-limited period of post-ischemic heightened neuronal plasticity during which intensive training may optimally affect the recovery of gross motor skills, indicating that the timing of rehabilitation is as important as the dosing. However, recent literature indicates a controversy regarding both the value of intensive, high dosage as well as the optimal timing for therapy in the first two months after stroke. Our study is designed to empirically investigate this controversy. Furthermore, current service delivery models in the United States limit treatment time and length of hospital stay during this period. In order to facilitate timely discharge from the acute care hospital or the acute rehabilitation setting, the initial priority for rehabilitation is independence in transfers and ambulation. This has negatively impacted the provision of intensive hand and upper extremity therapy during this period of heightened neuroplasticity. It is evident that providing additional, intensive therapy during the acute rehabilitation stay is more complicated to implement and difficult for patients to tolerate, than initiating it in the outpatient setting, immediately after discharge. Our pilot data show that we are able to integrate intensive, targeted hand therapy into the routine of an acute rehabilitation setting. Our system has been specifically designed to deliver hand training when motion and strength are limited. The system uses adaptive algorithms to drive individual finger movement, gain adaptation and workspace modification to increase finger range of motion, and haptic and visual feedback from mirrored movements to reinforce motor networks in the lesioned hemisphere. We will translate the extensive experience gained in our previous studies on patients in the chronic phase, to investigate the effects of this type of intervention on recovery and function of the hand, when the training is initiated within early period of heightened plasticity. We will integrate the behavioral, the kinematic/kinetic and neurophysiological aspects of recovery to determine: 1) whether early intensive training focusing on the hand will result in a more functional hemiparetic arm; (2) whether it is necessary to initiate intensive hand therapy during the very early inpatient rehabilitation phase or will comparable outcomes be achieved if the therapy is initiated right after discharge, in the outpatient period; and 3) whether the effect of the early intervention observed at 6 months post stroke can be predicted by the cortical reorganization evaluated immediately after the therapy. This proposal will fill a critical gap in the literature and make a significant advancement in the investigation of putative interventions for recovery of hand function in patients post-stroke. Currently relatively little is known about the effect of very intensive, progressive VR/robotics training in the acute early period (5-30 days) post-stroke. This proposal can move us past a critical barrier to the development of more effective approaches in stroke rehabilitation targeted at the hand and arm.

项目摘要 该应用程序寻求资金继续我们对密集，高剂量影响的持续调查 使用与复杂集成的触觉机器人对偏瘫手的任务和损伤训练 游戏和虚拟现实模拟。越来越多的工作表明有一个时间限度的时期 缺血后的神经元可塑性在此期间可能会最佳地影响恢复 总体运动技能，表明康复的时机与剂量一样重要。但是，最近 文献表明了关于密集，高剂量和最佳价值的争议 中风后的头两个月，治疗时间。我们的研究旨在凭经验研究 争议。此外，美国当前的服务交付模型限制了治疗时间和长度 在此期间住院。为了促进及时从急诊医院或 急性康复设置，康复的最初优先事项是转移和行动中的独立性。 在此期间，这对强化手和上肢疗法的提供产生了负面影响 神经可塑性提高。显然，在急性期间提供额外的强化疗法 与在 出院后立即门诊设置。我们的飞行员数据表明​​，我们能够整合密集型， 有针对性的手部治疗急性康复环境的常规。我们的系统专门 旨在在运动和力量有限时提供手训练。系统使用自适应算法 为了驱动单个手指运动，获得适应和修改工作空间以增加手指范围 运动，镜像运动的触觉和视觉反馈，以增强病变中的电机网络 半球。我们将翻译在先前对患者的研究中获得的丰富经验 慢性阶段，研究这种类型的干预对手的恢复和功能的影响 训练是在可塑性提高的早期开始的。我们将整合行为， 恢复的运动学/动力学和神经生理方面以确定：1）早期强化训练是否是否 专注于手将导致更具功能性的偏瘫臂； （2）是否有必要发起 在早期的住院康复阶段进行强化手动治疗，或者将是可比的结果 如果在出院后立即开始治疗，则可以在门诊期开始； 3）是否效果 评估的皮质重组可以预测中风后6个月的早期干预措施 治疗后立即。该提议将填补文献中的重要空白，并占据重大的 在研究后，卒中患者恢复手部功能的假定干预措施的进步。 目前，关于非常密集，进步的VR/机器人培训的影响相对较少 冲程后急性早期（5-30天）。该建议可以使我们摆脱发展的关键障碍 针对手臂和手臂的中风康复中更有效的方法。