Developing a wearable computing device to provide vibrotactile stimulation for spasticity relief post-stroke

项目摘要 中风是美国和全球残疾的主要原因。手臂和手部功能受限 中风后的恢复对幸存者的独立性和恢复健康生活是一个重大挑战。除了 无力、张力增加和痉挛是中风后手臂功能受损的主要原因，大约 40%的幸存者受到影响。有很少的有效治疗紧张和痉挛。 一个有希望的治疗，以减少紧张和痉挛中风后是振动触觉刺激（VTS）。有 令人鼓舞的初步数据，从我以前的研究以及其他人的表明，VTS改善语气， 痉挛我对14名中风患者进行了初步研究， 痉挛状态在8周内显示出痉挛状态的显著减少。其背后的确切机制 使用VTS后的恢复尚不清楚，但据信感觉反馈调节异常肌肉 活动使用VTS治疗卒中后痉挛状态的主要局限性是：（1） 了解刺激后恢复的机制，这是选择 优化恢复的VTS参数，以及（2）没有移动的设备可用于管理和研究 这种治疗方法在患者的家庭环境中持续很长时间。可穿戴VTS设备可以 提供密集的、移动的、非侵入性刺激。 这个F32博士后奖学金的目的是通知可穿戴VTS系统的设计， 减少中风后的紧张和痉挛。这将通过三个目标实现： 目的1 -表征皮肤和本体感受振动指骨刺激对肌肉的影响 活性和相互抑制。 目标2 -制定可穿戴设备的设计指南，可供痉挛用户使用。 目的3 -确定VTS位置对中风患者的张力和痉挛的影响。 总之，这些目标将有助于阐明VTS缓解痉挛的潜在机制，并告知 开发一种可穿戴设备，可以帮助改善中风后的恢复。 该研究员专门研究可穿戴计算和触觉，沿着导师Allison Okamura博士 Maarten Lansberg博士（中风/神经病学）和Kara Flavin博士（物理医学 和康复）组成一个理想的团队来执行这项工作。包括临床研究设计的培训计划， 与患者一起工作，与其他临床研究者的互动将为研究员奠定坚实的基础， 未来在健康相关领域的技术创新。斯坦福大学中风诊所设计中心 研究，以及正在进行的临床试验，使用VTS，以减少痉挛，提供了一个很好的 环境来进行这项研究。

PROJECT SUMMARY Stroke is a leading cause of disability both in the United States and globally. Limited arm and hand function after a stroke can be a major challenge to a survivor’s independence and return to a healthy life. In addition to weakness, increased tone and spasticity are major causes of impaired arm function after stroke, with around 40% of survivors affected. There are very few effective treatments for tone and spasticity. A promising treatment to reduce tone and spasticity after stroke is vibrotactile stimulation (VTS). There is encouraging preliminary data from my prior research as well as others’ indicating that VTS improves tone and spasticity. My pilot study with VTS of the phalanx using a glove-based system in 14 stroke patients with spasticity has shown significant reductions in spasticity over 8 weeks. The exact mechanisms underlying recovery after using VTS are unknown, but it is believed that sensory feedback modulates abnormal muscle activity. Key limitations to the use of VTS for treatment of spasticity post-stroke are: (1) there is limited understanding of the mechanisms underlying recovery from stimulation, which is needed to inform selection of VTS parameters to optimize recovery, and (2) there are no mobile devices available to administer and study this method of therapy for prolonged periods in the patient's home environment. A wearable VTS device could provide intensive, mobile, noninvasive stimulation. The purpose of this F32 postdoctoral fellowship is to inform the design of a wearable VTS system for the reduction of tone and spasticity after stroke. This will be achieved through three aims: Aim 1 – Characterize the influence of cutaneous and proprioceptive vibratory phalanx stimulation on muscle activity and reciprocal inhibition in healthy people. Aim 2 – Develop design guidelines for a wearable device that is accessible to users with spasticity. Aim 3 – Determine the influence of VTS location on tone and spasticity in stroke patients. Together, these aims will help elucidate mechanisms underlying VTS for spasticity relief, and inform the development of a wearable device that may help improve recovery after stroke. The Fellow, who specializes in Wearable Computing and haptics, along with mentors Dr. Allison Okamura (Mechanical Engineering), Dr. Maarten Lansberg (Stroke/Neurology), and Dr. Kara Flavin (Physical Medicine and Rehabilitation) form an ideal team to execute this work. A training plan that includes clinical study design, work with patients, and interaction with other clinical investigators will give the Fellow a strong foundation for future technical innovation in health-related domains. Stanford University’s Stroke Clinic, Center for Design Research, and an ongoing clinical trial on the use of VTS to reduce spasticity, provide an excellent environment to perform this research.