Promoting paretic limb use in stroke survivors using exoskeleton and virtual reality technologies

项目摘要 中风是美国的第五大死亡原因，近800万美国人将其报告为他们的死亡原因。 残疾的主要原因。对于许多中风导致的轻偏瘫患者，现有的康复治疗 未能持续改善功能恢复。这些疗法要么只关注 肢体受损或依赖于与日常生活活动几乎不相似的训练任务。新兴研究 表明，双边培训可以提供超越单方面培训的改善，但机制 这些好处的根本原因仍然不明。因此，本提案的目的是确定电机 控制和神经肌肉机制负责双边协调达成中风。为此我们 开发了一个康复平台，使用虚拟现实和外骨骼技术， 任务和环境的限制，以增加使用瘫痪肢体的慢性中风幸存者。 我们在健康对照组和4名中风参与者中的初步结果表明，我们的系统可以改变两种情况， 上肢伸展运动学和神经肌肉控制。我们的假设是偏瘫患者 中风参与者通过采用最佳伸手来响应这些新任务和环境约束 这种策略表现为受损手臂位移和肌肉活动的系统性变化。具体到 目的1我们将探讨双手伸臂时手臂位移和肌肉活动之间的平衡 任务和目标2中，我们将建立一个神经肌肉机制受损肢体招聘在这个任务。 具体来说，我们使用先进的肌电图技术来测量同源肌肉的共激活 对.总之，这两个目标将确定运动和神经肌肉机制负责 慢性卒中幸存者双侧协调功能的变化这项研究得到了以下方面的支持： 一个完善的导师团队，涵盖临床神经病学，康复科学和生物医学 工程.这项工作将在乔治城大学、MedStar 国家康复医院和美国天主教大学。这些机构完全是 整合以提供完成拟议工作所需的临床、技术和知识环境。 培训将包括指导急性和慢性中风幸存者的临床经验，并培训申请人 中风康复的先进工程方法。最后，培训计划旨在过渡 申请人进入独立的研究生涯，专注于探索下一代技术 解决治疗挑战。

PROJECT SUMMARY Stroke is the 5th leading cause of death in the United States, and nearly 8 million Americans report it as their primary reason for disability. For many with hemiparesis caused by their stroke, existing rehabilitative therapies have failed to deliver sustained improvements in functional recovery. These therapies either focus on only the impaired limb or rely on training tasks with little resemblance to activities of daily living. Emerging research suggests that bilateral training may provide improvements beyond unilateral training alone, but the mechanisms underlying these benefits remain unknown. Therefore, the objective of this proposal is to determine the motor control and neuromuscular mechanisms responsible for bilateral coordinated reaching in stroke. To do this, we have developed a rehabilitation platform that uses virtual reality and exoskeleton technologies to provide the task and environmental constraints necessary to increase the use of the paretic limb in chronic stroke survivors. Our preliminary results in healthy controls and 4 stroke participants show that our system can change both the kinematic and neuromuscular control of upper extremity reaching. Our overarching hypothesis is that hemiplegic stroke participants respond these novel task and environmental constraints by adopting an optimal reaching strategy that manifests as systematic changes in impaired arm displacement and muscle activity. Specifically, in Aim 1 we will explore the tradeoff between arm displacement and muscle activity during a bimanual reaching task and in Aim 2, we will establish a neuromuscular mechanism of impaired limb recruitment during this task. Specifically, we use an advanced electromyographical technique to measure coactivation of homologous muscle pairs. Together, these two Aims will identify the kinematic and neuromuscular mechanisms responsible for functional changes in bilateral coordination in chronic stroke survivors. The proposed research is supported by a well-established mentorship team the spans clinical neurology, rehabilitation sciences, and biomedical engineering. The work will be carried out in a unique collaboration between Georgetown University, the MedStar National Rehabilitation Hospital, and The Catholic University of America. These institutions are perfectly integrated to provide the clinical, technical, and intellectual environment needed to complete the proposed work. Training will include mentored clinical experience with acute and chronic stroke survivors and train the applicant in advanced engineering approaches to stroke rehabilitation. Finally, the training plan is designed to transition the applicant into an independent research career focused on exploring the next generation of technological solutions to therapeutic challenges.