Customizable cooperative multi-joint control to enhance walking mobility after stroke

大多数中风幸存者行走缓慢，摔倒的风险增加。因此，许多人采用了一种 久坐不动的生活方式，功能独立性有限，对健康有负面影响，可能会对社会产生影响 正在隔离。包括先进康复技术在内的物理疗法改善了功能，但没有 提供干预措施，使中、重度中风幸存者能够以较快的速度行走 对于独立的社区步行来说是必要的。这项工作的长期目标是恢复中风 幸存者以独立所需的速度在社区中安全行走的能力。我们的方法利用 植入式神经假体，这是一种在体内施加微小电脉冲来激活的装置 使服务于多个关节的肌肉以协调的方式收缩的神经 整个肢体的运动。该系统测量意志性肌肉活动和身体运动，然后 协调腿部不同关节的刺激，以产生安全行走所需的运动 与功能相关的速度。这种方法的好处是它始终可用，并且不需要 为手部控制受损的个人设置。植入的硬件还提高了可靠性和 绕过可能导致不适的感觉纤维。我们的团队在一个案例研究中表明，目标是 瘫痪肢体的肌肉可以显著提高行走速度和耐力。这项研究将 通过实现以下目标来扩大这项工作：1)确定植入的多发性骨水泥的临床影响 中风后步态的关节神经假体，以及2)开发和评估一种先进的神经假体 协同控制策略。这项研究将实施一种可用的神经假体，它结合了 外部控制单元和一些外部传感器，为实施完全植入的系统做准备 这是在我们的中心开发的。六名参与者将被植入包括12个通道的设备 用于记录肌肉活动的两个通道。外部传感器将测量肢体运动。之后 该装置被植入，将产生刺激模式，参与者将接受培训以使用 设备。我们将为家庭使用创建一个简单的触发模式，然后我们将实施我们的高级 通过机器学习技术在实验室中控制控制器。一旦控制器和刺激模式具有 ，我们将确定使用神经假体后行走的速度、安全性和简便性 并确认这些影响是否会随着时间的推移而保持。我们还将确定是否 先进的控制器大大提高了行走能力，而不是简单的触发方法 以前实施的。成功完成将确认卒中后神经假体治疗的方法 步行并为后续临床试验生成初步效果大小以评估家庭和社区 使用完全植入的系统。这项研究可能会导致一种新的临床工具，可以增强独立性 中风后步行，改善生活质量，增强中风幸存者的整体健康。

Most stroke survivors walk slowly and are at an increased risk of falls. As a result, many adopt a sedentary lifestyle with limited functional independence that negatively impacts health and can be socially isolating. Physical therapy including advanced rehabilitation techniques have improved function, but there is no intervention available that enables stroke survivors with moderate and severe impairment to walk at speeds necessary for independent community ambulation. The long-term goal of this work is to restore stroke survivors’ ability to walk safely in the community at speeds necessary for independence. Our approach utilizes an implanted neuroprosthesis, that is a device inside the body that applies small electrical pulses to activate the nerves that cause the muscles serving multiple joints to contract in a coordinated manner for functional movement of the entire limb. The system measures volitional muscle activity and body motion and then coordinates stimulation at the different joints in the leg to produce the necessary movement for safe walking at functionally relevant speeds. The benefit of such an approach is that it is always available and does not require setup for individuals with impaired hand control. The implanted hardware also improves reliability and bypasses sensory fibers that can cause discomfort. Our team has shown in a case study that targeting muscles throughout the paretic limb can substantially improve walking speed and endurance. This study will expand this work through achieving the following Aims: 1) determining the clinical impact of an implanted multi- joint neuroprosthesis on post-stroke gait, and 2) developing and assessing an advanced neuroprosthesis cooperative control strategy. This study will implement an available neuroprosthesis that incorporates an external control unit and some external sensors in preparation for implementation of a fully implanted system that has been developed at our Center. Six participants will be implanted with devices that include 12-channels of stimulation and 2-channels for recording muscle activity. External sensors will measure limb motion. After the device is implanted, stimulation patterns will be generated and participants will undergo training to use the device. A simple triggering pattern will be created for home use and then we will implement our advanced controller in the laboratory via machine-learning techniques. Once a controller and stimulation pattern have been defined, we will determine how much faster, more safely, and easier walking is with the neuroprosthesis compared to without and confirm whether these effects are maintained over time. We will also determine if the advanced controller substantially improves walking ability over the simple triggering methods that have been previously implemented. Successful completion will confirm approaches for a post-stroke neuroprosthesis for walking and generate preliminary effect sizes for subsequent clinical trials to evaluate home and community use of a fully implanted system. This study may lead to a new clinical tool that can empower independent walking after stroke, improve quality of life, and enhance overall health of stroke survivors.