AMES+Brain Stimulation: Treatment for Profound Plegia in Stroke

AMES 脑刺激：治疗中风严重麻痹

• 批准号: 7907962
• 负责人: Paul Cordo
• 金额: $ 23.36万
• 依托单位: AMES TECHNOLOGY, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7907962
• 关键词: Address; Adjuvant; Affect; Ankle; Area; Biofeedback; Brain; Categories; Chronic; Coupled; Couples Therapy; Devices; Disabled Persons; Esthesia; Figs - dietary; Fingers; Funding; Goals; Hand; Health Care Costs; Healthcare; Individual; Intervention; Joints; Lifting; Limb structure; Measures; Motion; Motor; Movement; Muscle; Muscle Contraction; Muscle Spindles; Muscle Weakness; Paralysed; Paresis; Patients; Population; Productivity; Quality of life; Recovery; Regimen; Rehabilitation therapy; Research; Robotics; Sensory Receptors; Signal Transduction; Stroke; Survivors; Testing; Therapeutic; Therapeutic Intervention; Thumb structure; Time; Torque; Treatment Protocols; United States National Institutes of Health; Visual; Work; chronic stroke; disability; effective therapy; electromyographic biofeedback; experience; foot; grasp; joint mobilization; post stroke; public health relevance; repetitive transcranial magnetic stimulation; robotic device; therapy design; treatment duration

DESCRIPTION (provided by applicant): An estimated 30% of chronic stroke patients with motor disabilities of the limbs are plegic in the hand or the foot - that is, they cannot move the hand or foot. While some plegic stroke patients have completely paralyzed muscles, without the ability to activate even minimally the plegic muscles ("profound plegia"), other plegic stroke patients are capable of producing volitional muscle activation, but are not strong enough to make the joint move ("pseudo plegia"). The long-term objective of this study is to restore functional movement to stroke patients with profoundly plegic muscles and with pseudo plegic muscles. Stroke is the leading cause of disability in the U.S., amounting to $50 billion in health care costs annually. Each year, about 700,000 US citizens suffer stroke, and those who survive without full recovery join a growing population of chronically disabled individuals currently totaling 5.8 million. Any therapeutic intervention that effectively treats plegic stroke patients will have significant impact on the productivity, quality of life, and healthcare expenses of stroke patients in the U.S. and worldwide. The work proposed in this application addresses the treatment of low functioning plegic stroke patients through the use of a recently developed therapeutic intervention called "AMES" (Assisted Movement with Enhanced Sensation). AMES therapy involves a robotic device that moves the paretic or plegic joint while the patient assists the motion and observes visual biofeedback - in the form of joint torque for paretic individuals, or muscle activity (EMG) for plegic individuals - about their level of assistance. While the robotic device moves the joint, vibrators on the AMES therapy device stimulate sensory receptors in the lengthening muscles to enhance the sensation of joint motion and displacement. AMES treatment has already been shown to be an effective treatment for most low-functioning stroke patients with paresis, helping them regain functional movement. In Aim 1, we will redesign the robotic grasp mechanism of the AMES device to increase its sensitivity so that it will be able to measure low levels of torque during AMES hand therapy - at levels beyond the capacity of the current AMES device. This increased sensitivity will allow us to detect with precision the point at which AMES therapy causes a patient to transition from plegia to paresis. In Aim 2, using AMES therapy combined with brain stimulation (rTMS or tDCS), our goal is to restore volitional EMG to profoundly plegic muscles and, thereby, convert these muscles into pseudo plegic muscles. PUBLIC HEALTH RELEVANCE: The proposed research addresses the sensorimotor rehabilitation of low-functioning stroke patients with hand plegia, a sub-population not served by currently available therapeutic approaches. The objective is to use "AMES" therapy in combination with brain stimulation to restore volitional muscle activity in this population. AMES+brain stimulation is envisioned to be the first of 3 forms of AMES therapy in a progressive therapeutic regimen for profoundly plegic stroke patients that would, first, restore volitional muscle activity (EMG) via AMES+brain stimulation, next, restore some minimal movement via AMES+EMG biofeedback, and lastly, restore functional movement via AMES+torque biofeedback.

描述（由申请人提供）：估计有30%的肢体运动障碍的慢性中风患者的手或脚瘫痪-也就是说，他们不能移动手或脚。虽然一些瘫痪的中风患者具有完全瘫痪的肌肉，但没有激活甚至最低限度的瘫痪肌肉的能力（“深度瘫痪”），但其他瘫痪的中风患者能够产生意志性肌肉激活，但不足以使关节移动（“假性瘫痪”）。这项研究的长期目标是恢复功能性运动的中风患者的深度瘫痪的肌肉和假性瘫痪的肌肉。中风是美国残疾的主要原因，每年高达500亿美元的医疗费用。每年，大约有70万美国公民遭受中风，那些没有完全康复的人加入了不断增长的慢性残疾人人口，目前总数为580万。任何有效治疗瘫痪中风患者的治疗干预措施都将对美国和全球中风患者的生产力、生活质量和医疗费用产生重大影响。本申请中提出的工作通过使用最近开发的称为“艾姆斯”（具有增强感觉的辅助运动）的治疗干预来解决低功能瘫痪中风患者的治疗。艾姆斯治疗涉及一种机器人设备，该设备移动麻痹或瘫痪的关节，同时患者辅助运动并观察视觉生物反馈-以麻痹个体的关节扭矩或瘫痪个体的肌肉活动（EMG）的形式-关于他们的辅助水平。当机器人装置移动关节时，艾姆斯治疗装置上的振动器刺激延长肌肉中的感觉受体，以增强关节运动和位移的感觉。艾姆斯治疗已经被证明是一种有效的治疗大多数低功能中风患者的轻瘫，帮助他们恢复功能性运动。在目标1中，我们将重新设计艾姆斯设备的机器人抓取机制，以提高其灵敏度，以便能够在艾姆斯手部治疗期间测量低水平的扭矩-超出当前艾姆斯设备的能力。这种增加的灵敏度将使我们能够精确地检测艾姆斯治疗导致患者从瘫痪转变为轻瘫的点。在目标2中，使用艾姆斯疗法结合脑刺激（rTMS或tDCS），我们的目标是恢复意志性EMG到深度瘫痪的肌肉，从而将这些肌肉转化为假性瘫痪肌肉。 公共卫生相关性：拟议的研究涉及手麻痹的低功能中风患者的感觉运动康复，这是一个目前可用的治疗方法无法服务的亚群。目的是使用“艾姆斯”疗法结合脑刺激来恢复这一人群的意志肌肉活动。艾姆斯+脑刺激被设想为用于深度瘫痪中风患者的渐进式治疗方案中的3种艾姆斯治疗形式中的第一种，首先，通过艾姆斯+脑刺激恢复意志性肌肉活动（EMG），其次，通过艾姆斯+EMG生物反馈恢复一些最小运动，最后，通过艾姆斯+扭矩生物反馈恢复功能性运动。