A 3-D Robot Design to Overcome Arm Dysfunction in Stroke

描述（由申请人提供）：运动协调障碍是最不容易理解的，但通常是中风后功能恢复最虚弱的。这些协调缺陷以异常肌肉协同作用的形式表达，并导致功能性残疾的有限和刻板的运动模式。肌肉协同作用中的这些限制的结果是肩外展和肘屈曲之间的异常耦合，这显著降低了中风个体对抗重力举起受损手臂的重量时的活动范围或工作空间。在STTR的第一阶段，开发并测试了手臂协调训练3-D系统（ACT 3D）的第一个原型。它由一个力控机器人、一个Biodex System 3座椅系统和一个紧凑的LCD视觉显示器组成。作为第一阶段的一部分，已经证明ACT 3D可以完全消除手臂的重量，或者在主动伸展过程中为肢体提供部分支撑。研究还表明，慢性中风患者可以通过训练克服重力引起的不协调，从而增加瘫痪手臂的工作空间。在本STTR的第二阶段，将通过开发和构建一个大大改进的商业产品来扩展第一阶段获得的结果。与原始原型相比，商业ACT 3D系统将具有更大的运动范围，减少中风患者所经历的惯性效应，并增加安全功能（目标1）。此外，它将提供直观的用户友好的软件，符合临床需求（目标2）.最后，将测试商用系统的性能，以进行一系列扩展的训练和强化任务，包括在惯性或粘性载荷存在下以及在等速或速度控制约束下在几个平面上进行伸展运动（目标3）。系统的性能将同时监测其易用性、整体安全性、感知惯性效应和视觉反馈系统的有效性。商业ACT 3D系统将被设计为提供生理（力量和协调）和功能（到达工作空间）性能的高分辨率测量，可用于评估康复干预的有效性。此外，商业ACT 3D系统将被设计用于实施新的康复干预措施，预计将增加中风患者的功能性接触能力。最后，设想的系统将是一种安全且相对紧凑的介入/测量设备，即使在最小的诊所也可以轻松部署。拟议的ACT 3D系统（本项目的第三阶段）的营销和销售将由Lam Design Management LLC、西北大学、Biodex Medical Systems和Hocoma，Inc.组成的联合体实现。7.商业ACT 3D系统将被设计为提供生理（力量和协调）和功能（到达工作空间）性能的高分辨率测量，可以很容易地用于评估康复干预的有效性。此外，商业ACT 3D系统将被设计用于实施新的康复干预措施，预计将增加中风患者的功能性接触能力。最后，设想的系统将是一种安全且相对紧凑的介入/测量设备，即使在最小的诊所也可以轻松部署。

DESCRIPTION (provided by applicant): Disturbances in movement coordination are the least well understood but often the most debilitating with respect to functional recovery following stroke. These deficits in coordination are expressed in the form of abnormal muscle synergies and result in limited and stereotypic movement patterns that are functionally disabling. The result of these constraints in muscle synergies is an abnormal coupling between shoulder abduction and elbow flexion, which significantly reduces reaching range of motion or workspace when an individual with stroke lifts the weight of the impaired arm against gravity. In Phase I of this STTR the first prototype of the Arm Coordination Training 3-D system (ACT3D) was developed and tested. It consists of a force controlled robot combined with a Biodex System 3 seating system and a compact LCD visual display. As part of Phase I, it was demonstrated that the ACT3D could be used to completely eliminate the weight of the arm or provide partial support of the limb during active reaching. It was also demonstrated that individuals with chronic stroke can be trained to overcome gravity-induced discoordination subsequently increasing the workspace of the paretic arm. During Phase II of this STTR, the results obtained in Phase I will be expanded upon by developing and building a greatly improved commercial product. The commercial ACT3D system will have an increased motion range, reduced inertial effects as experienced by the individual with stroke, and increased safety features compared with the original prototype (aim 1). Furthermore, it will offer intuitive user- friendly software that conforms to clinical demands (aim 2). Finally, the performance of the commercial system will be tested for an expanded set of training and strengthening tasks that include reaching movements in several planes, in the presence of inertial or viscous loads and under isokinetic or velocity-controlled constraints (aim 3). The performance of the system will be monitored simultaneously for its ease of use, overall safety, perceived inertial effects, and effectiveness of the visual feedback system. The commercial ACT3D system will be designed to provide high-resolution measurements of physiological (strength and coordination) and functional (reaching workspace) performance that can be readily employed in assessing the effectiveness of rehabilitation interventions. Additionally, the commercial ACT3D system will be designed for the implementation of novel rehabilitation interventions that are expected to increase the functional reaching abilities of individuals with stroke. Finally, the envisioned system will be a safe and relatively compact intervention/measurement device that can be easily deployed even in the smallest clinics. The marketing and sales of the proposed ACT3D system (Phase III of this project) will be realized by a consortium consisting of Lam Design Management LLC, Northwestern University, Biodex Medical Systems and Hocoma, Inc. 7. Project Narrative The commercial ACT3D system will be designed to provide high-resolution measurements of physiological (strength and coordination) and functional (reaching workspace) performance that can be readily employed in assessing the effectiveness of rehabilitation interventions. Additionally, the commercial ACT3D system will be designed for the implementation of novel rehabilitation interventions that are expected to increase the functional reaching abilities of individuals with stroke. Finally, the envisioned system will be a safe and relatively compact intervention/measurement device that can be easily deployed even in the smallest clinics.