Ankle Robotics Training after Stroke: Effects on Gait and Balance

描述(由申请人提供)： 项目摘要/摘要退伍军人和其他在中风中幸存下来的美国人经常面临致残运动障碍，这些障碍阻碍了日常生活活动的表现，限制了自由生活活动。其中最突出的是运动功能减弱和平衡受损，这不仅养成了久坐不动的生活方式和身体状况，而且还增加了因跌倒而受伤的风险。我们巴尔的摩VAMC的团队和世界各地的其他机构最近的研究表明，基于运动学习的干预措施可以改善中风患者的大脑活动和改善运动功能。现在有了一个重大的研究机会，可以通过应用新的机器人技术来改善对步态和平衡等基本功能的神经运动控制，从而提高这些干预的有效性。行走和站立平衡的一个关键领域是对脚踝的控制，因为脚踝是步态中机械力量的主要渠道，也调节着影响平衡时全身重心运动的扭矩。因此，目前的建议旨在研究两种方法，即使用阻抗控制的踝关节机器人来改善患有慢性下肢偏瘫的中风幸存者的步态和平衡功能。一种方法是在坐式视觉运动训练计划中使用脚踝机器人，重点是改善偏瘫的脚踝运动控制，这种控制可能会转移到步态和平衡功能。另一种方法遵循占主导地位的特定任务训练的康复范例，在跑步机运动训练中结合使用脚踝机器人来评估对相同结果的影响。这两种机器人方法的有效性将与没有机器人的跑步机锻炼计划进行比较。这项研究验证了一种假设，即在慢性下肢偏瘫患者中，6周的坐位式踝关节机器人训练将改善偏瘫患者的踝关节运动控制，主要改善站立平衡，适度改善步态，而同等数量的脚踝机器人在跑步机上训练将改善步态功能，而不是平衡。在平衡方面，两个机器人训练组的表现都将优于单纯跑步机训练组，而跑步机+机器人训练组在步态方面的进步最大，坐姿机器人训练组在步态上有所改善，但在踝关节运动控制和平衡方面表现出更大的进步。目的：在对慢性下肢偏瘫患者进行的为期6周(18节)的干预中，1)比较坐式视觉运动踝关节机器人训练与跑步机+机器人训练对偏瘫踝关节损伤和运动控制的效果；2)比较坐式机器人与跑步机+机器人训练对功能活动和平衡结果的影响；以及3)比较两种机器人方法在相同持续时间的标准跑步机锻炼方案中的有效性。这项提议将建立两种基于运动学习的方法的初步比较效果，使用模块化阻抗控制的踝关节机器人，并对比它们之间的运动控制和功能步态和平衡结果。作为一项试点研究，我们将为在6周内对每次干预做出反应的用户建立初始赤字概况。这将开始填补如何在老年中风人群中应用机器人技术的知识空白。这些发现有可能改变中风护理的范式，基于我们对依赖活动的大脑可塑性的理解的进步，以及在退伍军人和其他残疾人士康复中改善流动性的迫切需要。我们的结果将提供必要的信息，以设计一项更大的功绩奖试验，改进或结合这些干预措施，以减少日益增长的中风人口中残疾和有限的社会参与的风险因素。 公共卫生相关性： 拟议工作与退伍军人保健特派团的相关性退伍军人保健特派团寻求改善中风等疾病致残后退伍军人的一般健康状况和生活质量。使用一种新的脚踝机器人设备，这项研究测试了两种旨在改善中风后步态和平衡功能的新方法。在一种方法中，受试者使用机器人玩脚踝视频游戏，另一种方法是在跑步机上行走时使用机器人。目标是重新学习对虚弱的脚踝的运动控制，以改善步态和平衡。这些方法最终可能会对其他神经功能障碍有所帮助，包括从最近的战争中归来的退伍军人的神经损伤。一般来说，这种机器人技术的使用可能有助于重塑退伍军人管理局内的康复模式，方法是允许更长的培训课程，促进更密集的课程，并使治疗师能够在给定时间与更多退伍军人管理局患者一起工作，从而增强治疗的有效性和范围。

DESCRIPTION (provided by applicant): Project Summary/Abstract Veterans and other Americans who survive stroke often face disabling motor impairments that impede performance of activities of daily living and limit free-living activity. Prominent among these are diminished locomotor function and impaired balance that not only foster a sedentary lifestyle and physical deconditioning, but also increase the risk injuries due to falls. Recent research from our group at the Baltimore VAMC and others around the world has demonstrated how motor learning based interventions can modify brain activity and improve motor functions in persons with stroke. Now there is a major research opportunity to advance the effectiveness of these interventions by applying new robotics technologies to improve neuromotor control of essential functions such as gait and balance. One critical area for performance of walking and standing balance is the control of the ankles, as they are a major conduit of mechanical power in gait and also modulate torques affecting the motion of the whole body center of mass when balancing. Thus the current proposal is designed to investigate two approaches for using an impedance controlled ankle robot to improve gait and balance function among stroke survivors with chronic lower extremity hemiparesis. One approach uses the ankle robot in a seated visuomotor training program that focuses on improving paretic ankle motor control that may transfer to gait and balance functions. The other approach follows the dominant rehabilitation paradigm of task-specific training by integrating use of the ankle robot during treadmill exercise training to assess effects on the same outcomes. The effectiveness of both robotics approaches will be compared to that of a treadmill exercise program without robotics. The study tests the hypothesis that, in persons with chronic lower extremity hemiparesis, 6 weeks of seated ankle robot training will improve paretic ankle motor control with major improvements in standing balance and moderate improvements in gait, whereas the same amount of training on the treadmill with the ankle robot will improve gait function more than balance. Both robot-trained groups will outperform the treadmill only group on balance, while the treadmill + robot group will make the greatest gains in gait and the seated robot group will make some improvement in gait but will show greater gains in ankle motor control and balance. Aims: In a 6-week intervention (18 sessions) with persons with chronic lower extremity hemiparesis 1) Compare effects of seated visuomotor ankle robot training vs. treadmill + robot training on paretic ankle impairments and motor control; 2) Compare effects of seated-robot vs. treadmill + robot training on functional mobility and balance outcomes; and 3) Compare the effectiveness of both robotics approaches to a standard treadmill exercise protocol of the same duration. This proposal will establish the initial comparative efficacy of two motor learning based approaches using a modular impedance controlled ankle robot and contrast motor control and functional gait and balance outcomes among them. As a pilot study we will establish initial deficit profiles for users that respond to each intervention across the 6-week period. This will begin to fill the knowledge gap on how to apply robotics technologies in the elderly stroke population. Such findings have the potential to change the paradigm of stroke care based upon advances in our understandings of activity-dependent brain plasticity and the critical need for improving mobility in the rehabilitation of Veterans and others with disabilities. Our results will provide the requisite information to design a larger Merit Award trial that refines or combines these interventions to reduce risk factors for disabilities and limited social participation in the growing stroke population. PUBLIC HEALTH RELEVANCE: Relevance of the Proposed Work to the VA Health Care Mission The VA patient care mission seeks to improve the general health status and quality of life of Veterans after disabling diseases such as stroke. Using a novel ankle robotics device, this study tests two new approaches aimed at improving gait and balance function after a stroke. In one approach subjects use the robot to play ankle videogames and the other uses the robot while walking on a treadmill. The goal is to re-learn motor control of the weaker ankle to improve gait and balance. These approaches may eventually help in other neurologic disabilities, including neurologic injuries among returning Veterans from recent wars. Generally, such uses of robotics may help to reshape rehabilitation models within the VA by augmenting the effectiveness and scope of therapy by allowing longer training sessions, facilitating more intensive sessions, and enabling therapists to work with larger numbers of VA patients at a given time.