CANDIDATE SCREENING FOR UPPER EXTREMITY NEUROPROSTHESIS AFTER STROKE

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。这项研究的目的是确定可能受益于植入式神经假体的中风患者，这种假体通过电刺激瘫痪的肌肉来恢复手臂和手部的运动。中风后上肢偏瘫患者必须具备以下特征，才有资格使用现有的神经假体：1)表面刺激可恢复上肢关节的全部活动范围（AROM），但自愿性AROM有限；2)如果存在引起AROM限制的肌肉高张力，可以通过药物或手术治疗减少到表面刺激完全恢复AROM的程度；3)潜在候选人可以使用肌电控制策略和/或外部关节角度传感器和开关准确可靠地调制命令信号；4)当刺激被主体调节时，表面刺激仍然有效地恢复完全的AROM。表现出这些特征的受试者将被进一步评估，以确定在哪些肌肉上植入刺激和记录电极，以及如果有的话，需要进行哪些外科手术。然后，希望进行神经假体植入的受试者将在家中使用表面刺激器进行肌肉强化练习，并将参加一个单独的研究方案，包括手术和术后评估。本研究的受试者将因中风而患有上肢偏瘫，并导致手臂和手的功能缺陷。他们可能有也可能没有上肢肌肉高张力。运动范围和标准卒中损害评估，以及上肢关键肌肉的表面电刺激将用于确定是否需要治疗肌肉强直，然后再进行进一步的筛选评估。作为这项研究的一部分，将提供三种标准的高张力降低方案：口服药物、神经松解和鞘内巴氯芬。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this study is to identify stroke patients who may benefit from an implantable neuroprosthesis that restores arm and hand motion by electrically stimulating paralyzed muscles. The following characteristics must be true of individuals with post-stroke upper extremity hemiparesis for them to be eligible for the existing neuroprosthesis: 1) Surface stimulation restores full active range of motion (AROM) in upper extremity joints with limited voluntary AROM; 2) If muscle hypertonia that causes AROM limitations exists, it can be reduced with medical or surgical treatments to the extent that surface stimulation restores full AROM; 3) The potential candidate can accurately and reliably modulate a command signal using a myoelectric control strategy and/or external joint angle transducers and switches; 4) Surface stimulation remains effective in restoring full AROM when the stimulation is modulated by the subject. Subjects who exhibit these characteristics will be further evaluated to determine which muscles to implant with stimulating and recording electrodes, and what, if any, augmentative surgical procedures are needed. Subjects who then desire to proceed to neuroprosthesis implementation will be prescribed muscle strengthening exercises to do at home with a surface stimulator and will be enrolled in a separate research protocol covering the surgery and post-operative evaluations. Subjects enrolled in this study will have upper extremity hemiparesis due to stroke, with resulting functional deficits of the arm and hand. They may or may not have hypertonic upper extremity muscles. Range of motion and standard stroke impairment assessments, along with surface electrical stimulation of key upper extremity muscles will be used to determine whether treatment of muscle hypertonia is required before further screening evaluations are performed. Three standard hypertonia-reducing options will be available as part of this study: oral medications, neurolysis, and intrathecal baclofen.