Arm Motor Rehabilitation, Entertainment and Cognition System for the Elderly

描述（由申请人提供）：假设在熟练护理机构（SNF）中与老年卒中幸存者居民一起使用机器人康复床和虚拟现实游戏将：1）改善和维持上肢单手和双手功能、伸展、力量和ADL独立性; 2）改善和维持认知（记忆力，注意力，解决问题）; 3）提供情绪提升并保持它。这实施了一种综合的，单点护理的安全康复方法。该项目的目标是：1）开发一种新型的单手和双手训练设备，比康复机器人更便宜和更安全; 2）一种基于虚拟现实的适应性和综合性维护程序，临床上有效，并吸引老年中风幸存者和其他患者群体。具体目标1）开发用于改善SNF居民慢性卒中后的臂/肩运动范围、肩部力量、耐力、抓握力量、双手功能和ADL独立性、短期记忆、专注力、执行功能并减少抑郁的SRF Arm Duo系统; 2）通过多部位、纵向、一项为期12个月的中风幸存者随机对照研究。方法：1）通过设计和构建新的跟踪工作表面和计算机化前臂支撑来构建MPEG-Arm Duo系统; 2）开发自定义康复游戏，其中包含单手和双手运动和认知训练元素，并自动适应每个患者。游戏应该联合收割机，以诱导>350次重复/会话; 3）开发一个安全的网络访问数据库模块，用于游戏数据存储和分析，并能够与其他SNF中的居民进行比赛。数据将在播放期间以真实的时间透明地采样并上传到BCI临床服务器; 4）可用性研究， 5）对新泽西两个SNF的老年中风幸存者进行纵向、多地点随机对照研究。受试者将随机分为对照组（N=16）和实验组（N=32）。对照组将继续现有的健康维护计划。实验组将有现有的维护程序加上额外的8周初始强化训练，然后定期“助推器”康复课程。所有受试者将接受多次评估 由不知情的临床医生进行身体和认知/情感功能测试。两个机构的现有维护计划将记录在所有研究受试者的管理中。实验组将评估双臂治疗的有效性和获得的ADL独立性。NIH RELEVANCE一种用于单/双手手臂康复和认知/情绪治疗的新器械和治疗/维护方法，可在单点护理中使用。该方法可以扩展到其他患有运动和认知共病的患者人群，包括急性、亚急性和慢性、成人和儿童。 公共卫生相关性：公共卫生相关性：在美国，与中风相关的费用每年接近500亿美元。一种同时改善和维持手臂单手和双手功能、增加手臂力量、改善专注力和记忆力并提升士气的产品，有益于老年中风幸存者和其他患者人群（创伤性脑损伤、创伤后应激障碍、慢性疼痛、阿尔茨海默病、儿科）。该产品有助于降低医疗保健成本的单点护理治疗。

DESCRIPTION (provided by applicant): It is hypothesized that the use robotic rehabilitation tables coupled with virtual reality games with elderly stroke survivors residents in skilled nursin facilities (SNFs) will: 1) improve and maintain upper extremity uni-manual and bimanual function, reach, strength and ADL independence; 2) improve and maintain cognition (memory, focus, problem solving); and 3) provide emotive uplifting and maintain it. This implements an integrative, single-point-of-care safe rehabilitation approach. The objectives of the project are 1 to develop a novel uni-manual and bimanual training device that is cheaper and safer than rehabilitation robots; 2) a virtual reality-based adaptable and integrative maintenance program that is clinically effective and engaging for elderly stroke survivors and other patient population. SPECIFIC AIMS 1) to develop the BrightArm Duo system for improving arm/shoulder motion range, shoulder strength, endurance, grasp strength, bimanual function and ADL independence, short-term memory, focusing, executive function and reduce depression in SNF residents chronic post-stroke; 2) to evaluate the new system for rehabilitation and maintenance therapy through a multi-site, longitudinal, randomized controlled study of stroke survivors over a 12 month period. METHODS 1) Construct the BrightArm Duo system by designing and building a new tracking work surface and computerized forearm supports; 2) Develop custom rehabilitation games that incorporate uni- and bimanual motor and cognitive training elements and automatically adapt to each patient. The games should combine to induce >350 repetitions/session; 3) Develop a secure web-accessible database module for game data storage and analysis and ability to play against residents in other SNFs. Data will be sampled transparently in real time during play and uploaded to BCI clinical server; 4) Usability study with healthy elderly adults, to uncover technical problems; 5) Longitudinal, multi-site randomized controlled study with elderly stroke survivors that are residents at two SNFs in New Jersey. Subjects will be randomized into a control group (N=16) and an experimental group (N=32). The control group will continue with existing health maintenance programs. The experimental group will have existing maintenance program plus an additional 8 week initial intensive training, followed by periodic "booster" rehabilitation sessions. All subjects will have multiple evaluations by blinded clinicians for physical and cognitive/emotive function. Existing maintenance programs at the two facilities will be documented in administration to all study participants. The experimental group will rate the BrightArm Duo therapy usefulness and gained independence in ADLs. NIH RELEVANCE A new device and therapeutic/maintenance method for uni/bimanual arm rehabilitation and cognition/emotive therapy in a single-point-of-care. The approach can be extended to other patient populations with motor and cognitive co-morbidities acute, sub-acute and chronic, adult and paediatric. PUBLIC HEALTH RELEVANCE: Public Health Relevance: Costs associated with stroke are close to 50 billion a year in the United States. A product the simultaneously improves and maintains arm uni-manual and bimanual function, increases arm strength, improves ability to focus and memory, and lifts morale benefits elderly stroke survivors and other patient populations (traumatic brain injury, post-traumatic stress disorder, chronic pain, Alzheimer's Disease, pediatric). The product facilitates a single-point-of-care therapy that reduces health care costs.