Home therapy for upper limb stroke rehabilitation using the HandSOME exoskeleton

在美国，每年有80万人新中风。功能性 卒中后上肢瘫痪的改善主要取决于肢体功能的改善。 瘫痪的手，然而中风后手功能的恢复往往滞后于更多的恢复 近端关节和损伤往往对治疗干预具有抵抗力。其基本原理是 我们的方法源于越来越多的证据表明，中风后的神经康复可能是 通过在重复学习的背景下应用运动学习策略来加强 动作练习。这些策略的关键治疗方面是高度重复， 意志的努力，并成功地完成任务，防止挫折。而这些代表着 前景看好的治疗策略，它们仅限于已经患有轻度损伤的受试者 对手指伸展有足够的控制，以容忍高重复的抓取/释放任务 屈服于疲惫和沮丧。有很大一部分中风患者 不属于这一类，经常必须依靠效率低下的补偿策略。在这些 对于患者来说，无人协助的重复任务练习可能不是最佳的再培训策略。 在此之前，我们已经开发了SIMARY(手动弹簧操作运动启动器)，一个 被动外骨骼，在简单的抓握模式中提供伸展辅助。 帅哥价格便宜，重量轻，患者可以独立佩戴。手 佩戴帅气时，运动范围和功能立即增加，并使 成功地练习伸展和抓握任务，即使在手部严重损伤的受试者中也是如此。 这项研究的具体目的是在我们的基础上对协议进行一些改进 从试点测试中获得的经验，以提高保留率并在家庭中评估这一新方案 慢性中风受试者的训练研究。

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. The rationale for our approach stems from the growing evidence that neuro-rehabilitation after stroke may be enhanced via the application of motor learning strategies within the context of repetitive movement practice. The key therapeutic aspects of these strategies are high repetition, volitional effort, and successful completion of tasks to prevent frustration. While these represent promising therapeutic strategies, they are limited to mildly impaired subjects who already have enough control of finger extension to tolerate high repetitions of grasp/release tasks without succumbing to fatigue and frustration. There is a very large population of stroke patients who don't fall into this category and often must rely on inefficient compensatory strategies. In these patients, unassisted repetitive task practice may not be the optimal retraining strategy. Previously we have developed HandSOME (Hand Spring Operated Movement Enabler), a passive exoskeleton that provides extension assistance during a simple grasp pattern. HandSOME is inexpensive, lightweight and can be donned independently by patients. Hand range-of-motion and function is increased immediately when wearing HandSOME and enables successful practice of reach and grasp tasks, even in subjects with severe hand impairment. The specific aims of this study are to make several protocol improvements based on our experiences from pilot testing to improve retention and evaluate this new protocol in a home training study with chronic stroke subjects.