Robot therapy for rehabilitation of hand movement after stroke

描述（由申请人提供）：美国每年有80万例新发中风。中风后上肢瘫痪的功能改善主要取决于瘫痪手的改善，但中风后手功能的恢复往往滞后于更近端关节的恢复，并且损伤往往对治疗干预有抵抗力。文献的系统性综述报告称，使用上肢治疗机器人可获得运动控制方面的收益，但几乎没有证据表明对ADL能力的恢复有任何影响。这可能是预期的，因为相对较少的临床试验已经进行了机器人，可以解决手的功能。我们已经开发出HEXORR，一个手机器人，是独特的能力，赋予协调运动的15个手指和拇指的自由度内的权力和捏把握模式。HEXORR还应用自动适应受试者表现的辅助模式，目的是在不接管受试者任务的情况下放大受试者的动作。这确保了主体的积极参与和运动任务的完成，以避免主体的挫折和被动。将在手功能受损的亚急性中风受试者中进行临床试验。将45名受试者随机分配到18小时的HEXORR训练、36小时的HEXORR训练或18小时的常规治疗。将在治疗期前后和6个月随访时进行临床和生物力学评价。结果将决定机器人手治疗的有效性。这项研究将为天主教大学的生物医学工程本科生提供一个参加NIH资助的临床试验的机会。要求提供资金，以支持两个全年的本科实习生。他们将由一名研究生和临床工作人员监督。他们将参与研究的各个方面，包括与中风受试者进行培训，制定测试方案，分析数据和传播结果。我们相信，在结构化研究方案的背景下与患者的这种直接互动是激励学生追求康复博士水平研究事业的关键因素。

DESCRIPTION (provided by applicant): There are 800,000 new strokes in the United States each year. Functional improvement of the upper paretic limb after stroke is mainly determined by improvement of the paretic hand, yet restoration of hand function after stroke often lags behind restoration of more proximal joints, and impairments are often resistant to therapeutic intervention. Systemic reviews of the literature report that using upper limb therapy robots results in gains in motor control, but there is little evidence of any effect on recovery of ADL ability. This may have been expected since relatively few clinical trials have been performed with robots that can address hand function. We have developed HEXORR, a hand robot that is unique in its ability to impart coordinated movement of 15 finger and thumb degrees-of-freedom within power and pinch grasp patterns. HEXORR also applies assistance patterns that automatically adapt to subject performance, with the goal of amplifying subject movements without taking over the task from the subject. This ensures active engagement on the part of the subject and completion of movement tasks to avoid frustration and passivity on the part of the subject. A clinical trial will be performed in subacute stroke subjects with impaired hand function Fourty-five subjects will be randomly assigned to 18 hours of training in HEXORR, 36 hours of training in HEXORR or 18 hours of conventional therapy. Clinical and biomechanical evaluations will be performed before and after the treatment period and at a 6-month followup. The results will determine the effectiveness of robotic hand therapy. This study will provide an opportunity for Biomedical Engineering undergraduates at Catholic University to participate in a NIH-funded clinical trial. Funds are requested to support two year-round undergraduate interns. They will be supervised by a graduate student and clinical staff. They will participate in all aspects of the study, including running of training sessions with stroke subjects, development of the testing protocols, analysis of data and dissemination of results. We believe this direct interaction with patients in the context of a structured research protocol is a key factor that wil motivate students to pursue doctoral level research careers in rehabilitation.