Restoring Upper Limb Movement Sense to Amputees; a Move Towards Natural Control o

恢复截肢者上肢运动感觉；

• 批准号: 8775031
• 负责人: Paul D. Marasco
• 金额: $ 43.05万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-12-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8775031
• 关键词: Achievement; Address; Amputation; Amputees; Artificial Arm; Back; Biological; Brain; Caring; Clinical; Cognitive; Cutaneous; Data; Devices; Elbow; Engineering; Esthesia; Eye; Feedback; Generations; Goals; Hand; Human; Illusions; Individual; Investigation; Investments; Joint Prosthesis; Joints; Kinesthesis; Kinesthetic Illusions; Limb Development; Limb Prosthesis; Limb structure; Link; Location; Maps; Measures; Methods; Modeling; Motion; Motor; Movement; Muscle; Muscle Spindles; Nerve; Nervous system structure; Operative Surgical Procedures; Perception; Peripheral; Peripheral Nerves; Play; Population; Positioning Attribute; Process; Proprioception; Prosthesis; Psychophysics; Public Health; Research; Robotics; Role; Sensory; Sensory Receptors; Skin; Solutions; Structure; System; Technology; Testing; Time; Tissues; Touch sensation; Translating; United States National Institutes of Health; Upper Extremity; Upper limb movement; Vision; Visual; Visual attention; Work; Wrist; arm; brain machine interface; clinical application; design; innovation; insight; limb amputation; limb movement; motor control; novel; pressure; prevent; public health relevance; receptor; reinnervation; relating to nervous system; research study; restoration; restraint; robot interface; robotic device; sensory feedback; sensory integration; standard of care; tool; vibration; visual tracking

DESCRIPTION (provided by applicant): In recent years there has been a substantial investment in research to create dexterous, multi- functional, prosthetic limbs for restoration of upper limb function following amputation. The focus on prosthetic limb development has, has in many ways, been fueled by advances in clinically operational motor neural- machine-interfaces; such as Targeted Reinnervation, the surgical redirection of amputated nerves for motor control of multifunction limbs, and other brain and peripheral neural-machine-interfaces on the near horizon. Although these motor interfaces provide considerable advantage to the control of the new prosthetic limbs, which are wonders of modern engineering, a fundamental problem still remains. Without natural and intuitive sensory feedback artificial limbs are still just insensate tools. Proprioception is the basic ability to sense where your arm is in space without looking. Amputees lack this sensory feedback, and this is the fundamental challenge in the implementation of advanced prosthetic limbs. Vision confirmation is needed for an amputee to use a prosthesis; from the most basic device to the most advanced. This is the key issue that we seek to address with our research objectives. We propose to attack the problem of prosthetic limbs that lack kinesthetic feedback in 3 Aims focused on developing and implementing approaches to harness and utilize a cognitive illusion of limb movement in human amputees with targeted sensory reinnervation. This research is important to the NIH scientific enterprise because it is highly translational and results directly impact amputee care. We hypothesize that we can stimulate the appropriate sensory receptors in the reinnervated tissue of targeted reinnervation amputees to generate the "kinesthetic illusion" and provide a sense of physiologically relevant limb movement for prosthetic limbs. Aim 1) We will use vibration and pressure to selectively activate the illusion and look at how targeted reinnervation amputees perceive this kinesthetic input. Aim 2) We will develop a small wearable robotic interface to selectively activate the kinesthetic receptors and assign sensations of limb movement to a prosthesis. With this we will look at how the subject interprets joint angle from a neutrally connected but physically unattached prosthesis. We will evaluate limb function with psychophysical examination of internal dynamic models related to constant velocity movements. We will also evaluate function using eye tracking and motion capture to track visual loading during prosthesis use. Aim 3) The prosthetic socket is the physical junction between the prosthesis and the amputee. This junction will need to evolve to reflect implementation restraints of the robot interface. To address this we will develop new socket designs to provide a limb movement feedback system with clinical applicability. PUBLIC HEALTH RELEVANCE: This research is relevant to public health because it is highly translational and the results will likely directly impact standard of care for amputees. As of 2011 there were 770,000 traumatic upper limb amputees in the US; a population that is young and active and will benefit substantially from more functional artificial arms that are neutrally integrated and provide a physiologically relevant sense of limb movement. Furthermore, our lines of investigation into neural interfaces and cognitive mechanisms of sensory feedback could provide far reaching scientific insight into challenges arising from sensory integration issues in many different fields.

描述（由申请人提供）：近年来，在研究中进行了大量投资，以制造用于截肢后上肢功能恢复的灵巧、多功能假肢。对假肢开发的关注在许多方面受到临床操作运动神经-机器接口的进步的推动;例如靶向神经再支配、用于多功能肢体的运动控制的截肢神经的手术重定向，以及近期的其他脑和外周神经-机器接口。虽然这些运动接口为控制新的假肢提供了相当大的优势，这是现代工程的奇迹，但一个根本问题仍然存在。没有自然和直观的感觉反馈，假肢仍然只是麻木的工具。 本体感觉是一种基本的能力，可以在不看的情况下感知手臂在空间中的位置。截肢者缺乏这种感觉反馈，这是实施先进假肢的根本挑战。截肢者使用假肢需要视力确认;从最基本的设备到最先进的设备。这是我们在研究目标中寻求解决的关键问题。 我们建议在3个目标中攻击缺乏动觉反馈的假肢的问题，这些目标集中在开发和实施方法来利用和利用人类截肢者的肢体运动的认知错觉与有针对性的感觉神经再支配。这项研究对NIH的科学事业很重要，因为它具有高度的转化性，其结果直接影响截肢者的护理。我们假设，我们可以刺激适当的感觉受体的神经支配的组织中的目标再支配截肢者产生的“动觉错觉”，并提供一种感觉的生理相关的肢体运动的假肢。目的1）我们将使用振动和压力来选择性地激活错觉，并观察有针对性的神经再移植截肢者如何感知这种动觉输入。目的2）我们将开发一种小型可穿戴机器人接口，以选择性地激活动觉受体并将肢体运动的感觉分配给假肢。通过这个，我们将观察受试者如何从中性连接但物理上独立的假体中解读关节角度。我们将评估肢体功能与心理物理检查的内部动态模型相关的恒定速度运动。我们还将使用眼动追踪和动作捕捉来评估功能，以追踪假体使用期间的视觉负荷。目的3）接受腔是假肢与截肢者之间的物理连接。这个连接点需要不断发展，以反映机器人接口的实现限制。为了解决这个问题，我们将开发新的插座设计，以提供具有临床适用性的肢体运动反馈系统。 公共卫生相关性：这项研究与公共卫生有关，因为它具有高度的转化性，其结果可能会直接影响截肢者的护理标准。截至2011年 在美国有770，000名创伤性上肢截肢者;这是一个年轻且活跃的群体，并且将从更多功能的人造手臂中受益，这些人造手臂是中性整合的并且提供生理上相关的肢体运动感觉。此外，我们对感觉反馈的神经接口和认知机制的研究可以为许多不同领域的感觉整合问题所带来的挑战提供深远的科学见解。