Brain-computer interface-functional electrical stimulation for stroke recovery

项目摘要 仅在美国就有超过700万中风幸存者，每年约有795,000例新病例。尽管 在现有的最佳物理疗法中，30%-60%的中风幸存者仍然受到步态功能障碍的影响， 脚部下垂往往是主要原因。鉴于中风后步态障碍仍处于次优解决状态， 能够提供持久的神经和功能改善的新方法是必要的。 脑机接口(BCI)技术可能就是这样一种新方法。脑-机接口技术支持直接 通过翻译大脑电生理学，大脑控制外部设备，如辅助设备和假肢- 将CAL信号(例如，EEG)转换为控制信号。当脑机接口系统与功能性电刺激相结合时 FES系统，它们可以用来提供一种新的物理疗法，以改善中风后的运动功能。BCI- FES系统被假设为刺激希伯来的可塑性过程(其中fi神经元聚集在一起，连接在一起 共同“)，这种方法可能会导致中风后的功能恢复超过传统的物理治疗- APY。申请者的初步研究表明，将这种技术应用于中风后的脚下垂是安全的 并可能通过神经过程改善步态功能。因此，这需要进一步调查：1.确定是否 BCI-FES疗法可为伴有足下垂的慢性中风患者提供持续的步态功能改善；2.确定 fl-FES治疗的影响因素；3.明确阐明其潜在的神经修复机制。 首先，一项针对慢性中风所致足部下垂患者的第二阶段临床试验将比较脑机接口的疗效。 fl背部刺激疗法与剂量和强度相匹配的标准理疗(目标1)。比较 两组之间步态速度和其他次要结果指标的改善将测试 假设BCI-FES疗法提供了比传统物理疗法更好的功能和神经收益- 碘疗法。它还将确定哪些方面的步态损害是BCI-FES治疗的最佳解决方案 而不是传统的理疗。受试者的基线特征(步态速度、 背部fl兴奋功能、运动诱发电位、脑电特征、感觉)和预后 确定fl-FES背部fl刺激治疗的反应性特征(目标2)。最后，潜在的 驱动BCI-FES神经功能改善的机制将使用显式计算来阐明 中风康复的神经科学模型，由实验神经生理学测量提供信息(目标3)。 确定BCI-FES疗法可以提供比传统疗法更好的改善可能会导致 一种新的神经修复机制，可以有效地治疗中风患者。这种机制可以为设计提供信息 未来的理疗技术或改进现有的技术。最后，BCI-FES疗法可能最终成为一种 新的理疗形式，减少中风后的残疾，进而减轻中风的公共卫生负担。

Project Summary There are over 7 million stroke survivors in the US alone, with approximately 795,000 new cases annually. Despite the best available physiotherapy, 30-60% of stroke survivors remain affected by gait function impairments, with foot drop often being the primary cause. Given that post-stroke gait impairments remain suboptimally addressed, novel methods that can provide lasting neurological and functional improvements are necessary. Brain-computer interface (BCI) technology may be one such novel approach. BCI technology enables “direct brain control” of external devices such as assistive devices and prostheses by translating brain electrophysiologi- cal signals (e.g. EEG) into control signals. When BCI systems are integrated with functional electrical stimulation (FES) systems, they can be used to deliver a novel physiotherapy to improve motor function after stroke. BCI- FES systems are hypothesized to stimulate a Hebbian plasticity process (where “neurons that fire together, wire together”), and this approach may lead to functional recovery after stroke beyond that of conventional physiother- apy. The applicant's preliminary research indicates that applying this technique to foot drop after stroke is safe and may improve gait function via neural processes. Hence, this warrants further investigation to: 1. determine if BCI-FES therapy can provide lasting gains in gait function in chronic stroke patients with foot drop; 2. determine what factors influence BCI-FES therapy; and 3. explicitly elucidate the underlying neural repair mechanisms. First, a Phase II clinical trial in patients with foot drop due to chronic stroke will compare the effect of BCI- FES dorsiflexion therapy to that of dose- and intensity-matched standard physiotherapy (Aim 1). Comparing the improvement in gait velocity and other secondary outcome measures between the two groups will test the hypothesis that BCI-FES therapy provides functional and neurological gains beyond those of conventional phys- iotherapy. It will also determine which aspects of gait impairment are best addressed with BCI-FES therapy versus conventional physiotherapy. The relationship between the subjects' baseline characteristics (gait velocity, dorsiflexion function, motor evoked potentials, electroencephalogram features, sensation) and the outcomes will determine what features influence responsiveness to BCI-FES dorsiflexion therapy (Aim 2). Finally, the underlying mechanism driving the neurological improvements of BCI-FES will be elucidated using an explicit computational neuroscience model of stroke recovery, informed by experimental neurophysiological measurements (Aim 3). Determining that BCI-FES therapy can provide improvements beyond that of conventional therapy may lead to a new neural repair mechanism that can be effective in stroke patients. This mechanism can inform the design of future physiotherapy techniques or improve current ones. Finally, BCI-FES therapy may ultimately become a novel form of physiotherapy to reduce post-stroke disability, and in turn reduce the public health burden of stroke.