Rehabilitation Using Community-Based Affordable Robotic Exercise Systems (Rehab CARES)

项目总结 中风是导致长期严重残疾的主要原因。据估计，目前有580万至650万人 美国有中风相关的残疾患者，到2030年这一数字将增加20.5%。当前的美国 卫生基础设施没有为这些不断增加的数字做好准备。医疗保险覆盖范围的限制和 康复从业者的短缺减少了获得康复的机会。基于社区的设置包括 然而，作为提供长期中风后护理的可行场所，它们受到工作人员有限的困扰 专业知识不足，治疗师人数较少，缺乏康复财政资源。正因为如此，质量 护理的效果受到影响，患者的功能结果不等同于医院康复 设置。我们试图为这个问题开发一种新的解决方案。实施经济实惠的设计是一个基本的 增加患者获得康复技术的机会的战略，无论患者的社会经济地位如何。 这样做，缩小了医疗差距，并降低了长期医疗成本。我们建议使用 负担得起的机器人，以改善在低资源、以社区为基础的环境中获得优质康复护理的机会。在……里面 第一阶段，我们利用一个带有控制算法的1自由度触觉机器人来开发测试版 机器人硬件和软件。新的机器人有一个新颖的末端执行器，可以使手臂和手的种类更多 锻炼，连接到基于云的游戏，并提供针对患者的调整运动的治疗 损害和认知损害。15名具有广泛运动障碍程度的中风患者将 完成运动和认知障碍的临床评估，然后进行基于机器人的评估和 心理治疗游戏。受试者将使用传感器监测关键的上肢肌肉活动，躯干 机器人执行任务期间的活动和心率。一个关键的里程碑将是识别来自机器人的运动学度量 与运动和认知障碍的临床分数有很强相关性和预测性的任务。另一个里程碑将是 通过调整机器人的控制参数和游戏参数来驱动针对患者的策略。在……里面 第二阶段，我们将开发硬件，允许三个触觉机器人对接(一个健身房)，并配置为允许 让患者单独或合作玩治疗游戏。我们将测试健身房的安全性和可行性。 以社区为基础的康复环境，中风患者通常每人接受1小时的物理治疗 (PT)、作业疗法(OT)和言语疗法(SLP)。36名患者将被随机分配到机器人(RT) 或对照组(CT)。两组都将接受PT和SLP，但RT将接受机器人体操治疗 瞄准上肢和CT将获得剂量匹配的一小时OT。治疗将在4周内进行 并进行了两次后续评估。关键里程碑将是展示RT具有相同或更好的功能 结果、动机和不良事件作为CT。此外，为了表明机器人健身房是一个具有成本效益的解决方案 在资源匮乏、以社区为基础的环境中增加获得优质康复护理的机会。在这里取得成功将 验证这一潜在的解决方案，证明通过用户反馈和更大的临床试验揭示的设计更改是合理的。

PROJECT SUMMARY Stroke is the leading cause of serious long-term disability. It is estimated that 5.8–6.5 million people currently live with stroke related disability in the US and that this number will increase by 20.5% by 2030. The current US health infrastructure is not prepared for these increasing numbers. Limitations in health insurance coverage and the shortage of rehabilitation practitioners decrease access to rehabilitation. Community-based settings are becoming viable venues for delivering long-term post-stroke care, however, they are plagued by staff with limited expertise, low number of therapists and lack of financial resources for rehabilitation. Because of this, the quality of care is compromised, and functional outcomes of patients are not equal to hospital-based rehabilitation settings. We seek to develop a novel solution to this problem. Implementing affordable design is a fundamental strategy for increasing access to rehabilitation technology for patients regardless of socio-economic status. Doing so, decreases healthcare disparities and reduces long-term healthcare costs. We propose to use affordable robots to improve access to quality rehabilitation care in low-resource, community-based settings. In Phase 1, we leverage a 1 degree of freedom haptic robot with control algorithms to develop a beta version of the robot hardware and software. The new robot have a novel end-effector to allow more diverse arm and hand exercises, be connected to cloud-based gaming, and provide patient-specific therapy that adjusts for motor impairment and cognitive impairment. 15 stroke patients with a wide range of motor impairment levels will complete clinical assessments of motor and cognitive impairment followed by robot-based assessment and therapy games. Subjects will be instrumented with sensors monitoring key upper extremity muscle activity, trunk activity and heart rate during robot tasks. A key milestone will be to identify kinematic metrics from the robot tasks that strongly correlate and predict clinical scores of motor and cognitive impairment. Another milestone will to drive patient-specific strategies by adjusting the robot’s control parameters and the game parameters. In Phase 2, we will develop the hardware to allow three haptic robots to dock (a gym) and be configured to allow patients to play therapy games alone or collaboratively. We will test the safety and feasibility of the gym in a community-based rehabilitation setting where stroke patients typically receive 1 hour each of physical therapy (PT), occupational therapy (OT) and speech therapy (SLP). 36 patients will be randomized to either a robot (RT) or a control group (CT). Both groups will receive PT and SLP, but the RT will receive the robot gym therapy targeting the upper limb and the CT will receive a dose-matched hour of OT. Therapy will occur over 4 weeks with two follow-up assessments. Key milestones will be to show that the RT has the same or better functional outcomes, motivation, and adverse events as the CT. Also, to show that the robot gym is a cost-effective solution to increasing access to quality rehabilitation care in low-resource, community-based settings. Success here will validate this potential solution, justify design changes revealed via user-feedback and a larger clinical trial.