Promoting paretic limb use in stroke survivors using exoskeleton and virtual reality technologies

使用外骨骼和虚拟现实技术促进中风幸存者使用偏瘫肢体

• 批准号: 10605387
• 负责人: Alexander Brunfeldt
• 金额: $ 6.95万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-07 至 2024-09-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10605387
• 关键词: 3D virtual reality; Activities of Daily Living; Acute; Adopted; American; Bilateral; Biological Assay; Biomedical Engineering; Cause of Death; Central Nervous System; Chronic Phase; Clinical; Collaborations; Couples; Coupling; Custom; Data; Electromyography; Engineering; Environment; Feedback; Force of Gravity; Future; Goals; Hand; Hemiplegia; Hospitals; Impairment; Individual; Institution; Knowledge; Learning; Limb structure; Manuals; Measures; Mentors; Mentorship; Monitor; Movement; Muscle; Neurology; Neurons; Output; Paresis; Participant; Patients; Pattern; Persons; Phenotype; Process; Publications; Recovery of Function; Regulation; Rehabilitation therapy; Reporting; Research; Research Personnel; Resistance; Stroke; Sum; Surface; System; Techniques; Technology; Testing; Therapeutic; Tissues; Training; Translating; United States; Universities; Upper Extremity; Visual; Weight; Work; acute stroke; arm; arm function; biceps brachii muscle; career; chronic stroke; control theory; deltoid muscle; design; disability; efficacious treatment; exoskeleton; experience; functional disability; hemiparesis; improved; individual patient; innovation; kinematics; motor control; neural; neuromuscular; next generation; novel; novel strategies; recruit; rehabilitation science; restoration; stroke patient; stroke rehabilitation; stroke survivor; virtual; virtual reality; virtual reality environment; virtual reality system

PROJECT SUMMARY Stroke is the 5th leading cause of death in the United States, and nearly 8 million Americans report it as their primary reason for disability. For many with hemiparesis caused by their stroke, existing rehabilitative therapies have failed to deliver sustained improvements in functional recovery. These therapies either focus on only the impaired limb or rely on training tasks with little resemblance to activities of daily living. Emerging research suggests that bilateral training may provide improvements beyond unilateral training alone, but the mechanisms underlying these benefits remain unknown. Therefore, the objective of this proposal is to determine the motor control and neuromuscular mechanisms responsible for bilateral coordinated reaching in stroke. To do this, we have developed a rehabilitation platform that uses virtual reality and exoskeleton technologies to provide the task and environmental constraints necessary to increase the use of the paretic limb in chronic stroke survivors. Our preliminary results in healthy controls and 4 stroke participants show that our system can change both the kinematic and neuromuscular control of upper extremity reaching. Our overarching hypothesis is that hemiplegic stroke participants respond these novel task and environmental constraints by adopting an optimal reaching strategy that manifests as systematic changes in impaired arm displacement and muscle activity. Specifically, in Aim 1 we will explore the tradeoff between arm displacement and muscle activity during a bimanual reaching task and in Aim 2, we will establish a neuromuscular mechanism of impaired limb recruitment during this task. Specifically, we use an advanced electromyographical technique to measure coactivation of homologous muscle pairs. Together, these two Aims will identify the kinematic and neuromuscular mechanisms responsible for functional changes in bilateral coordination in chronic stroke survivors. The proposed research is supported by a well-established mentorship team the spans clinical neurology, rehabilitation sciences, and biomedical engineering. The work will be carried out in a unique collaboration between Georgetown University, the MedStar National Rehabilitation Hospital, and The Catholic University of America. These institutions are perfectly integrated to provide the clinical, technical, and intellectual environment needed to complete the proposed work. Training will include mentored clinical experience with acute and chronic stroke survivors and train the applicant in advanced engineering approaches to stroke rehabilitation. Finally, the training plan is designed to transition the applicant into an independent research career focused on exploring the next generation of technological solutions to therapeutic challenges.

项目总结 中风是美国第五大死因，近800万美国人报告说这是他们的 致残的主要原因。对于许多中风导致的偏瘫患者来说，现有的康复疗法 未能在功能恢复方面带来持续的改善。这些疗法要么只关注于 肢体受损或依赖于训练任务，与日常生活活动几乎没有相似之处。新兴研究 提示双边训练可能会提供比单边训练更好的改善，但机制 这些好处背后的原因尚不清楚。因此，这项建议的目标是确定电机 控制和神经肌肉机制在中风中负责双侧协调伸展。为了做到这一点，我们 开发了一个使用虚拟现实和外骨骼技术的康复平台，为 增加慢性卒中幸存者偏瘫肢体使用所需的任务和环境限制。 我们在健康对照组和4名中风患者中的初步结果表明，我们的系统可以改变 上肢伸展的运动学和神经肌肉控制。我们最重要的假设是偏瘫 中风患者通过采用最佳到达方式来应对这些新的任务和环境限制 表现为手臂移位和肌肉活动受损的系统性变化的策略。具体而言，在 目的1我们将探索在双手伸展时手臂移位和肌肉活动之间的权衡。 在目标2中，我们将在这项任务中建立受损肢体招募的神经肌肉机制。 具体地说，我们使用一种先进的肌电图学技术来测量同种肌肉的共同激活。 成对的。这两个目标将共同确定运动和神经肌肉机制负责 慢性卒中幸存者双侧协调功能的变化。拟议的研究得到以下支持 一支久负盛名的导师团队，涵盖临床神经学、康复科学和生物医学。 工程学。这项工作将在乔治敦大学、MedStar 国立康复医院和美国天主教大学。这些机构是完美的 集成以提供完成拟议工作所需的临床、技术和智力环境。 培训将包括指导急慢性中风幸存者的临床经验，并培训申请者 在中风康复的先进工程方法方面。最后，将培训计划设计为过渡 申请者进入了独立研究生涯，专注于探索下一代技术 治疗挑战的解决方案。