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Cognitive-based Rehabilitation Platform of Hand Grasp after Spinal Cord Injury using Virtual Reality and Instrumented Wearables

使用虚拟现实和仪器化可穿戴设备的脊髓损伤后手部抓握认知康复平台

基本信息

批准号：
10733413
负责人：
NOAM Y. HAREL
金额：
--
依托单位：
JAMES J PETERS VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-12-01 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10733413
关键词：
Acceleration Achievement Activities of Daily Living Auditory Award Binding Cervical Cervical spinal cord injury Chronic Cluster Analysis Cognition Cognitive Conscious Coupled Cues Custom Devices Elbow Electromyography Environment Esthesia Feedback Feeling Future Goals Hand Hybrids Impairment Isometric Exercise Learning Learning Skill Length Link Machine Learning Measures Modality Motivation Motor Movement Muscle Nervous System Trauma Neurosciences Outcome Paralysed Participant Pathway interactions Pattern Perception Performance Persons Physical Rehabilitation Physical therapy Physical therapy exercises Positioning Attribute Process Quality of life Real-Time Systems Rehabilitation device Rehabilitation therapy Research Resistance Secure Self-Help Devices Sensory Services Shapes Shoulder Speed Spinal cord injury Stroke Subconscious Tactile Techniques Technology Tendon structure Testing Therapeutic Time Touch sensation Training Translating Traumatic Brain Injury Upper arm Variant Veterans Visual Work algorithm training arm cognitive enhancement cohort computerized efficacy testing exercise rehabilitation exoskeleton functional electrical stimulation functional outcomes functional restoration grasp hand dysfunction hand grasp hand rehabilitation haptic feedback haptics improved innovation instrument invention machine learning algorithm motor learning multisensory neuromuscular novel operation physical process powered exoskeleton powered prosthesis rehabilitation research research and development sensor sensory feedback sound synergism technology platform time interval vibration virtual virtual reality virtual reality environment visual feedback wearable device

项目摘要

PROJECT SUMMARY Spinal cord injury (SCI) at the cervical level impairs hand function and the ability to engage the environment. As a result, the ability to perform activities of daily living can be severely compromised, directly leading to reduced quality of life. Physical therapy is still the primary pathway to restore functional abilities after SCI. The physical rehabilitation process requires commitment by the participant to achieve meaningful gains in function. Rehabilitation approaches that are cognitively engaging can facilitate greater commitment to practice and improved movement learning. We propose to develop innovative platforms that utilize virtual reality (VR) and instrumented wearables that enhance cognitive factors during motor learning of hand grasp and reach after SCI. These factors include greater sense of agency, or perception of control, and multi-sensory feedback. Sense of agency is implicated with greater movement control, and various sensory feedback modalities (visual, audio, and haptic) are proven effective in movement training. However, these factors are not well considered in traditional physical therapy approaches. We have developed two novel cognitive-based platforms for rehabilitating grasp and reach function. We propose to test each platform in Veterans with chronic SCI at the cervical level. In Aim 1, we will investigate how our first platform, the “cognition” glove, may improve functional grasp. This glove includes force and flex sensors that provide inputs to a machine learning algorithm trained to predict when secure grasp is achieved. The glove alerts the user of secure grasp through onboard sensory modules providing visual (LED), audio (beeper), and tactile (vibrator) feedback. During training, feedback is provided at gradually shorter time-intervals to progressively induce agency based on the neuroscience principle of ‘intentional binding’. This principle suggests that with greater agency, one perceives their action (i.e., secure grasp) is more coupled in time to a sensory consequence (i.e., glove feedback). Our glove is user-ready, and now has compatibility with customized VR applications to provide enhanced sensory feedback through engaging and customized visual and sound alerts. We hypothesize that enhanced feedback in VR will produce even greater improvements in grasp performance than onboard feedback alone. In Aim 2, we investigate how Veterans with SCI may learn greater arm muscle control during virtual reaching. We have developed a “sensory” brace that provides isometric resistance to one arm to elicit electromyography (EMG) patterns that can drive a virtual arm. The person receives visual feedback from VR and muscle tendon haptic feedback from the brace during training. Tendon stimulation can elicit movement sensations that modulate muscle activation patterns. The VR feedback will provide conscious movement training cues while vibration feedback will subconsciously elicit more distinct EMG patterns based on cluster analysis. We hypothesize that the promotion of distinct EMG patterns, achieved by maximizing inter-cluster distances, will improve performance of a reach-to-touch task. Performance of both the grasp and reach task in each Aim is assessed according to metrics that describe the timing, efficiency, and accuracy of movement. For a future MERIT proposal, we intend to integrate these platforms to train better operation of powered assistive devices, including a hybrid (motor power and functional electrical stimulation of muscle) exoskeleton of the hand. Importantly, the concept of strengthening cognitive agency and learning of movement using wearable technology, multi-sensory feedback, and virtual reality during physical training will be applicable to all forms of neuromuscular impairment, including stroke and traumatic brain injury in addition to SCI. Our team is ideally positioned to take the next steps in developing, translating, and applying this technological approach, which matches the Rehabilitation Research and Development Service’s goals.

项目总结