Myoelectrolytically controlled device in acute rehabilitation after stroke

近30%的中风幸存者最初有严重的手臂损伤，无法实现足够的手臂恢复 功能，使他们能够独立地进行日常生活活动。功能缺陷可以改善 通过将康复与前景看好的新技术相结合。肌电控制装置利用弱者 由受影响的肌肉产生的电信号并放大它们以激活设备中的马达。这个 马达的运动增强了他们自己在与该马达相关的关节中的意志运动。因此， 该设备为使用者提供了移动瘫痪手臂所需的支撑。A-Myopro是一种可调节的 肌电控制的矫形器，通过提供 通过四种行动模式提供援助。A-Myopro用户可以使用单一模式或多个模式进行培训 模式可以组合在一起，以允许对个人或多关节运动进行更复杂的训练。因此，a- Myopro为手臂功能受限的中风患者提供了一种独特的运动训练范例， 允许他们自愿地练习孤立的手臂动作，否则他们不能自己练习。 在中风发作后的第一周，受伤的大脑经历了几种神经机制，一种 这一过程被称为神经可塑性，旨在重组神经连接并修复受损的 损伤区域周围的组织。几项研究表明，在这一急性期康复将 增强偏瘫手臂的功能结果可能是通过调节增强的神经再生 机制。具体地说，有人建议，增强神经再生能力的新型干预措施 对于严重受损的中风幸存者来说，尤其需要康复机制。 CDA1提案的基本原理是探索肌电控制设备a-Myopro是否可以 增加了严重手臂缺陷的中风患者的急性康复。这项研究还将调查是否 与标准护理相比，a-Myopro的应用将导致临床结果的更大改善。 由于神经可塑性在急性期增强，这项研究旨在将神经生理学与 在这一人群中，由于练习a-Myopro而获得的增强的变化。因此，这一点 研究将检验这样的前提，即在重症患者的急性康复中增加a-Myopro的练习 手臂损伤作为一种新的康复工具，促进神经再生机制的恢复 改善这些受试者的临床结果。慢性中风受试者的初步数据为 这是本研究的中心前提。我们发现，接受18次治疗的慢性中风患者 使用Myopro的个性化实践的结果显示，偏瘫手臂的临床结果有所改善。在这 建议的研究，在急性康复阶段测试我的假设，10名急性缺血性中风患者(2 -中风后14天)将接受18次使用a-Myopro的个性化练习。中的改进 通过临床测量测量的上肢损害和功能将与以前进行比较 报告了标准护理结果。将使用神经生理学和神经成像工具来收集信息 在研究期间神经可塑性的变化。这份CDA-1将告知是否实施- 近视在急性康复中是可行的，并能改善研究人群的手臂功能。 在我过渡到临床神经康复领域时，这个项目对我来说是理想的。具体地说，使用 在我的主要导师和全面的指导团队的帮助下，我将开始接受(1)临床结果方面的培训 中风患者的测量，(2)神经康复研究中的神经生理学和神经成像工具，(3) 卒中的临床最佳实践和临床试验管理准备以及(4)成为 独立的临床研究员。我的项目与我成为一名领导者的职业目标高度结合 退伍军人医学中心临床神经康复研究员。

Almost 30 % of stroke survivors with initial severe arm impairment fail to achieve sufficient recovery of arm function to enable them to independently perform activities of daily living. Functional deficits can be improved by combining rehabilitation with promising new technologies. Myoelectrically controlled devices utilize the weak electrical signals generated by the affected muscles and amplify them to activate a motor in the device. The movement of the motor augments their own volitional movement in the joint associated with that motor. Hence, the device provides the user the support needed to move their paretic arm. a-Myopro is an adjustable myoelectrically controlled orthosis that facilitates movement of the paretic hand and elbow by providing assistance through four modes of movements. The a-Myopro user can train with a single mode, or multiple modes can be combined to allow for more complex training of individual or multi-joint movements. Thus, a- Myopro provides stroke subjects who have limited arm function a unique movement training paradigm that allows them to volitionally practice isolated arm movements that they otherwise cannot practice on their own. During the first weeks after the onset of stroke, the injured brain undergoes several neural mechanisms, a process known as neuroplasticity, that intend to reorganize the neural connectivity and repair the damaged tissue around the injury region. Several studies have revealed that rehabilitation during this acute period would enhance the functional outcome of the paretic arm presumably by modulating the heightened neuroplastic mechanism. Specifically, it has been suggested that novel interventions that enhance neuroplastic mechanisms of recovery are particularly needed for stroke survivors who are severely impaired. The rationale of this CDA1 proposal is to explore if the myoelectrically controlled device a-Myopro can be added to the acute rehabilitation of stroke subjects with severe arm deficits. The study will also investigate if application of a-Myopro would lead greater enhancement of clinical outcomes compared to standard care. Because neuroplasticity is heightened in the acute phase, the study aims to correlate the neurophysiological changes with the enhancement gained as a result of practicing with a-Myopro in this population. Thus, this study will test the premise that adding practice with a-Myopro to the acute rehabilitation of subjects with severe arm impairment acts as a novel rehabilitative tool that promotes the neuroplastic mechanisms of recovery to enhance clinical outcomes for these subjects. Preliminary data on chronic stroke subjects provides support for the central premise of this study. We have found that individuals with chronic stroke who receive 18 sessions of individualized practice using Myopro exhibit improvements in the clinical outcomes of the paretic arm. In this proposed study, to test my premise in the acute rehabilitation phase, ten subjects with acute ischemic stroke (2 – 14 days post stroke) will receive 18 sessions of individualized practice using a-Myopro. The improvements in upper extremity impairment and function measured by clinical measures will be compared to previously reported standard care results. Neurophysiological and neuroimaging tools will be used to collect information on the neuroplastic changes during the study period. This CDA-1 will inform whether implementation of a- Myopro in acute rehabilitation is feasible and leads to improvement in arm function in the study population. This project is ideal for me during my transition into clinical neurorehabilitation field. Specifically, with the help of my primary mentor and comprehensive mentoring team, I will begin to be trained in (1) clinical outcome measures for stroke subjects, (2) neurophysiological and neuroimaging tool in neurorehabilitation research, (3) clinical best practices in stroke and preparation for clinical trial management and (4) aspects to become an independent clinical researcher. My project is highly integrated with my career goal of becoming a leading investigator in clinical neurorehabilitation within the VA medical center.