CAREER: Neuromechanics of functional impairment of upper extremity following stroke and its effective restoration by retraining muscle activation patterns

PI: Lee， Sang wook提案号：1452763该项目是一项跨学科研究和教育活动的多年计划，旨在研究与中风后手臂和手部功能损伤相关的神经和生物力学因素。虽然中风对下肢和上肢功能的破坏性影响已被认识到，但上肢（手臂和手）的功能损害尤为严重。因此，迫切需要开发一种有效的策略来逆转对中风幸存者上肢功能的破坏性影响。但是，与上肢损伤相关的神经异常的复杂性及其复杂的生物力学，对理解与中风后上肢功能损伤相关的神经力学过程提出了重大挑战。本研究提出的新的实验和建模方法将有助于阐明中风后上肢损伤的机制，该项目的结果将引起研究中风神经生理学和神经科学的科学家、为中风幸存者设计康复设备的工程师以及治疗他们的医生和治疗师的极大兴趣。更重要的是，所提出的新型训练方法所带来的康复效果的改善将使患者受益，因为他们的生活质量将大大提高。此外，拟议的合作研究活动将加强美国天主教大学与国家之间的关系。芝加哥国立康复医院和芝加哥康复研究所，将为学生提供独特的教育机会，包括增强实验室经验，与患者和医生一起临床工作，以及在全国领先的康复医院的实践工作经验。该奖项由两个项目联合颁发：(1)生物医学工程，(2)一般和年龄相关残疾工程，均隶属于工程理事会的化学、生物工程、环境和运输系统部门。本项目旨在阐明脑卒中后上肢功能障碍的神经力学过程的关键方面，并开发一种新的策略来改善脑卒中患者的上肢功能。因此，前两个目的研究中风后上肢功能损害的以下方面：1)影响多肌肉控制的神经异常，以及2)这些异常转化为功能损害的生物力学途径。所提出的建模方法明显不同于现有的方法，因为多肌肉控制中的神经异常将从系统的角度进行检查，而不是专注于单个组件（目标1）；提出的生物力学模型是基于“基于力”的建模，这与传统的“基于矩”的建模技术形成对比（目标2）。从这些目标中获得的知识将用于追求项目的第三个目标（目标3），即开发能够有效促进患者神经可塑性的仿生装置；将开发一种新型的由“外肌腱”驱动的装置，模拟人体肌肉肌腱解剖结构，这将实现一种独特的康复训练方法，即有针对性地帮助受损肌肉（目标4）。这种辅助技术提出了一种专注于恢复肌肉协调性的新方法，这与现有的试图恢复运动学的方法有本质的不同，并且有望大大提高训练的康复效益。该项目的追求也将为美国天主教大学工程学院的学生提供独特的教育机会。与工程师、医生和治疗师组成的跨学科团队互动，学生将在顶级康复医院获得临床实践工作经验。研究人员计划在研究项目中特别吸引来自代表性不足的群体（即西班牙裔）的学生，他们将与患者密切合作，设计“针对患者的”设备。建议项目所涵盖的研究课题也将纳入课程。此外，拟议项目的教育效益将通过本科生实习生向哥伦比亚特区公立学校系统内的K-12学生进行一系列“案例研究”介绍，扩展到K-12 STEM教育。该项目涉及的广泛主题，包括生物力学、生物系统建模、神经信号/处理和设备设计，预计将极大地提高学生的“动手”经验，而拟议活动提供的研究机会将极大地帮助他们为成为成功的生物医学工程师做好准备。

PI: Lee, Sang WookProposal Number: 1452763The proposed project is a multi-year program of interdisciplinary research and educational activities that investigate neurological and biomechanical factors associated with functional impairment of the arm and hand post-stroke. While devastating impact of stroke on both lower and upper extremity function has been recognized, functional impairment of the upper extremity (arm and hand) is found to be particularly more severe. Thus there is an urgent need for the development of an effective strategy to reverse damaging impact on the upper extremity functionality for stroke survivors. But complexity of neurological abnormalities associated with the upper extremity impairment, along with its sophisticated biomechanics, poses substantial challenges to understanding neuromechanical processes associated with the functional impairment of upper extremity following stroke. The novel experimental and modeling methods proposed in the study will help clarify such mechanisms of the upper extremity impairment post-stroke, and the outcome of the proposed project will be of great interest to scientists studying neurophysiology and neuroscience of stroke, engineers designing rehabilitative devices for stroke survivors, and physicians and therapists treating them. More importantly, improved rehabilitation outcomes resulting from the proposed novel training method will benefit patients as their quality of life will be greatly improved. In addition, the proposed collaborative research activities will strengthen the relationship between the Catholic University of America and the nation?s leading clinics, the National Rehabilitation Hospital and the Rehabilitation Institute of Chicago, and will provide students with unique educational opportunities, including enhanced laboratory experience, clinical work with patients and physicians, and hands-on work experience in nation's leading rehabilitation hospitals. This award is being made jointly by two Programs: (1) Biomedical Engineering, (2) General and Age Related Disabilities Engineering, both in the Chemical, Bioengineering, Environmental and Transport Systems Division in the Engineering Directorate.This CAREER project attempts to elucidate key aspects of the neuromechanical process of the upper extremity functional impairment post-stroke, and to develop a novel strategy to improve upper extremity functionality of the stroke patients. Accordingly, the first two aims examine the following aspects of the functional impairment of upper extremity post-stroke: 1) neurological abnormalities affecting multi-muscle control, and 2) biomechanical pathway that such abnormalities translate into functional impairment. The proposed modeling methods clearly differ from existing approaches, as neurological abnormalities in multi-muscle control will be examined in a system perspective, rather than focusing on individual components (aim 1); and the proposed biomechanical model is based on "force-based" modeling, which contrasts to conventional "moment-based" modeling techniques (aim 2). The knowledge gained from these aims will be utilized to pursue the third aim of the project (aim 3), which is to develop biomimetic devices that can effectively promote neural plasticity of patients; a new type of devices driven by "exotendons", emulating human musculotendon anatomy, will be developed, which will enable a unique rehabilitation training method, i.e., targeted assistance of impaired muscles (aim 4). This assistance technique presents a new approach that focuses on restoration of muscle coordination, which is fundamentally different from existing approaches that attempt to restore kinematics, and is expected to greatly improve rehabilitative benefits of the training. The pursuit of the proposed project will also provide unique educational opportunities for students in the School of Engineering of the Catholic University of America. Interacting with an interdisciplinary team of engineers, physicians, and therapists, students will have clinical, hands-on work experience in top-ranked rehabilitation hospitals. The investigator plans to particularly engage students from underrepresented group (i.e., Hispanic origin) in the research projects, for which they will work closely with patients on "patient-specific" device design. Research topics covered by the proposed project will also be incorporated into the curriculum. Furthermore, the educational benefit of the proposed project will be extended to K-12 STEM education via a series of "case-study" presentations by the undergraduate interns to K-12 students within the District of Columbia Public School System. The broad spectrum of topics addressed by this project, including biomechanics, biological system modeling, neural signal/processing, and device design is expected to greatly improve students' "hands-on" experience, and research opportunities provided by the proposed activities will greatly help them prepare for their careers as successful biomedical engineers.