A wearable myoelectric computer interface to reduce muscle co-activation in acute and chronic stroke

中风偏瘫是世界上导致残疾的主要原因。中风后的手臂损伤不是由于 不仅与虚弱有关，而且还与肌肉协调受损--异常的协同激活--在尝试过程中 有动静。对于最严重受损的患者来说尤其如此，他们最需要新的 治疗。我们已经开发了一种肌电计算机接口(MCI)范式来补救这种共同激活。 这项研究的长期目标是开发一种负担得起的、可穿戴的MCI设备，它将改善电机 中风存活者的功能。然而，到目前为止，我们只研究了MCI在慢性中风幸存者中的应用。 实验室，使用笨重而昂贵的设备。关于中风后多久的信息很少 异常的共激活开始阻碍手臂的功能，但似乎在 急性期，大脑表现出更大的可塑性。此外，随着医疗资源变得越来越 更罕见的是，重要的是设计出便于携带和负担得起的新疗法，使其能够在 社区。该提议的目标是通过1)创建可穿戴的MCI来推进MCI范式 可在实验室外使用的设备，2)增强训练方案，以及3)在 中风幸存者在急性期和慢性恢复期。这项提议的中心假设是 这使得MCI治疗更密集，更接近日常运动，并在早期开始训练 中风的恢复，将导致更大的功能改善。我们将设计一款可穿戴设备并进行测试 在中风早期和晚期的中风幸存者中，这一假说通过这些特定的目的：1) 设计和实施可穿戴的MCI设备，控制基于平板电脑的治疗性游戏，2)开发 加强慢性卒中幸存者的家庭MCI训练，以及3)评估急性期的效果 MCI训练对卒中幸存者运动和功能的影响。这项提议的创新发展是 减少异常共激活的可穿戴设备范式将使我们能够研究MCI培训的好处 中风后的早期和晚期。实现我们的目标将是重要的，因为它将解决未实现的问题 需要开发廉价且可穿戴的中风新疗法，以实现广泛使用。我们 预计MCI培训将帮助手臂严重损伤和中度损伤的人， 因为严重受损的人有更多的异常共激活，而且由于MCI只需要一些残留 肌电活动，而不是明显的动作。我们还预计，这项提议将提供前所未有的 卒中后早期异常共激活的时间发展特征。这将影响我们的 全面了解中风的康复过程。我们预计MCI范式将是 与其他疗法协同，因为它有一种新的作用机制(使用肌电减少共同激活)。 最后，我们预计这项提案将提供关键结果，使我们能够翻译这项研究 进入临床试验。

Hemiparesis from stroke is the leading cause of disability in the world. Arm impairment after stroke is due not only to weakness, but also to impaired muscle coordination—abnormal co-activation—during attempted movement. This is especially true in the most severely-impaired patients, who are most in need of new treatments. We have developed a myoelectric computer interface (MCI) paradigm to remedy this co-activation. The long term goal of this research is to develop an affordable, wearable MCI device that will improve motor function in stroke survivors. However, to date we have studied MCI use only in chronic stroke survivors in the laboratory, using cumbersome and expensive equipment. Little information exists as to how soon after stroke abnormal co-activation starts to impede arm function, but it seems likely that averting it would be easier in the acute stage, when the brain exhibits greater plasticity. Moreover, as healthcare resources become ever scarcer, it is important to design new therapies that are portable and affordable to enable extensive use in the community. The objective of this proposal is to advance the MCI paradigm by 1) creating a wearable MCI device that can be used outside the laboratory, 2) enhancing the training regimen, and 3) testing the MCI in stroke survivors in both the acute and chronic stages of recovery. The central hypothesis of this proposal is that making MCI therapy more intense, more similar to everyday movements, and starting training early in stroke recovery, will result in even greater functional improvement. We will design a wearable device and test this hypothesis in stroke survivors in both early and late stages after stroke via these specific aims: 1) To design and implement a wearable MCI device that controls therapeutic, tablet-based games, 2) To develop and enhance home-based MCI training in chronic stroke survivors, and 3) To assess the effect of acute-phase MCI training on stroke survivors' movement and function. This proposal's innovative development of a wearable device paradigm to reduce abnormal co-activation will enable us to study the benefits of MCI training both early and late after stroke. Achieving our objectives will be significant because it will address unmet needs to develop new treatments for stroke that are inexpensive and wearable to enable widespread use. We expect MCI training will help people with severe arm impairment as well as those with moderate impairment, since the severely-impaired have more abnormal co-activation and since the MCI only requires some residual myoelectric activity, not overt movements. We also expect this proposal to provide an unprecedented characterization of the temporal development of abnormal co-activation early after stroke. This will impact our overall understanding of the process of recovery from stroke. We expect that the MCI paradigm will be synergistic with other therapies, since it has a novel mechanism of action (reducing co-activation using EMGs). Finally, we anticipate that this proposal will provide critical results that will position us to translate this research into clinical trials.