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

中风引起的偏瘫是世界上主要的残疾原因。中风后手臂损伤是由于 不仅对虚弱，而且对肌肉协调性受损-异常协同激活-在尝试 运动这在最需要新治疗的神经功能受损的患者中尤其如此。 治疗。我们已经开发了一个肌电计算机接口（MCI）的范例，以纠正这种共激活。 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， 中风幸存者的功能。然而，到目前为止，我们只研究了MCI在慢性卒中幸存者中的应用， 实验室，使用笨重和昂贵的设备。关于中风后多久的信息很少 异常的协同激活开始阻碍手臂功能，但似乎在正常情况下避免它会更容易。 急性期，此时大脑表现出更大的可塑性。此外，随着医疗保健资源越来越多， 因此，重要的是要设计便携式和负担得起的新疗法，以使其能够广泛用于 社区该提案的目的是通过以下方式推进MCI范例：1）创建可穿戴MCI 设备，可以在实验室外使用，2）加强训练方案，和3）测试MCI在 中风幸存者在急性和慢性恢复阶段。这一提议的核心假设是 使MCI治疗更强烈，更类似于日常运动，并在早期开始训练， 中风恢复，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 这一假设在中风后早期和晚期的中风幸存者中通过这些特定的目的：1） 设计和实现可穿戴MCI设备，控制治疗，基于平板电脑的游戏，2）开发 并加强慢性脑卒中幸存者的家庭MCI训练; 3）评估急性期MCI治疗的效果 MCI训练对中风幸存者的运动和功能。这一建议的创新发展， 减少异常共激活的可穿戴设备范例将使我们能够研究MCI训练的益处 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。 需要开发新的治疗中风的方法，这些方法既便宜又耐磨，以便广泛使用。我们 预计MCI训练将帮助手臂严重受损的人以及中度受损的人， 因为脑功能受损者具有更多的异常共激活， 肌电活动而不是明显的动作我们还希望这项提案能提供前所未有的 表征中风后早期异常共激活的时间发展。这将影响我们的 全面了解中风康复的过程。我们预计MCI范式将是 与其他疗法协同，因为它具有新的作用机制（使用EMG减少共激活）。 最后，我们预计，这一建议将提供关键的结果，这将使我们能够翻译这项研究 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.