Ankle Robotics Training after Stroke: Effects on Gait and Balance

描述（由申请人提供）： 项目摘要/摘要退伍军人和其他中风幸存的美国人经常面临致残性运动障碍，阻碍日常生活活动的表现，限制自由生活活动。其中最突出的是运动功能减弱和平衡受损，这不仅会导致久坐不动的生活方式和身体失调，而且还会增加因福尔斯跌倒而受伤的风险。我们在巴尔的摩VAMC的小组和世界各地其他人最近的研究已经证明了基于运动学习的干预如何改变脑活动并改善中风患者的运动功能。现在有一个重大的研究机会，通过应用新的机器人技术来提高这些干预措施的有效性，以改善步态和平衡等基本功能的神经运动控制。行走和站立平衡性能的一个关键领域是踝关节的控制，因为它们是步态中机械动力的主要管道，并且在平衡时还调节影响整个身体质心运动的扭矩。因此，目前的建议，旨在探讨两种方法，使用阻抗控制踝关节机器人，以改善步态和平衡功能的中风幸存者与慢性下肢轻偏瘫。一种方法是在坐姿视觉训练项目中使用踝关节机器人，该项目的重点是改善瘫痪的踝关节运动控制，该运动控制可以转移到步态和平衡功能。另一种方法遵循任务特定训练的主导康复范式，通过在跑步机运动训练期间整合使用踝关节机器人来评估对相同结果的影响。这两种机器人方法的有效性将进行比较，没有机器人的跑步机锻炼计划。该研究测试的假设是，在慢性下肢轻偏瘫的人，6周的坐姿踝关节机器人训练将改善瘫痪踝关节运动控制与站立平衡的重大改善和步态的中度改善，而相同量的训练与踝关节机器人在跑步机上将改善步态功能超过平衡。两个机器人训练组在平衡方面都优于仅跑步机组，而跑步机+机器人组将在步态方面取得最大的进步，而坐着的机器人组将在步态方面取得一些改善，但在踝关节运动控制和平衡方面将表现出更大的进步。目的：在为期6周的干预中，1）比较坐姿视觉踝关节机器人训练与跑步机+机器人训练对瘫痪踝关节损伤和运动控制的影响; 2）比较坐姿机器人与跑步机+机器人训练对功能移动性和平衡结果的影响;以及3）将两种机器人方法的有效性与相同持续时间的标准跑步机锻炼协议进行比较。该建议将建立两个运动学习为基础的方法，使用模块化阻抗控制的踝关节机器人和对比运动控制和功能步态和平衡结果之间的初步比较疗效。作为一项试点研究，我们将为在6周内对每次干预做出反应的用户建立初始赤字概况。这将开始填补如何在老年中风人群中应用机器人技术的知识空白。这些发现有可能改变中风护理的模式，这是基于我们对活动依赖性大脑可塑性的理解的进步，以及对改善退伍军人和其他残疾人康复活动能力的迫切需要。我们的研究结果将提供必要的信息，以设计一个更大的优异奖试验，完善或结合这些干预措施，以减少残疾的风险因素和有限的社会参与，在不断增长的中风人口。 公共卫生相关性： 拟议工作与退伍军人事务部医疗保健使命的相关性退伍军人事务部患者护理使命旨在改善退伍军人在罹患致残性疾病（如中风）后的总体健康状况和生活质量。使用一种新型的踝关节机器人设备，本研究测试了两种旨在改善中风后步态和平衡功能的新方法。在一种方法中，受试者使用机器人玩脚踝视频游戏，另一种方法是在跑步机上行走时使用机器人。目标是重新学习较弱踝关节的运动控制，以改善步态和平衡。这些方法最终可能有助于其他神经系统残疾，包括从最近的战争中返回的退伍军人中的神经系统损伤。通常，机器人技术的这种使用可以通过允许更长的训练课程、促进更密集的课程以及使治疗师能够在给定时间与更多的VA患者一起工作来增强治疗的有效性和范围，从而有助于重塑VA内的康复模型。

DESCRIPTION (provided by applicant): Project Summary/Abstract Veterans and other Americans who survive stroke often face disabling motor impairments that impede performance of activities of daily living and limit free-living activity. Prominent among these are diminished locomotor function and impaired balance that not only foster a sedentary lifestyle and physical deconditioning, but also increase the risk injuries due to falls. Recent research from our group at the Baltimore VAMC and others around the world has demonstrated how motor learning based interventions can modify brain activity and improve motor functions in persons with stroke. Now there is a major research opportunity to advance the effectiveness of these interventions by applying new robotics technologies to improve neuromotor control of essential functions such as gait and balance. One critical area for performance of walking and standing balance is the control of the ankles, as they are a major conduit of mechanical power in gait and also modulate torques affecting the motion of the whole body center of mass when balancing. Thus the current proposal is designed to investigate two approaches for using an impedance controlled ankle robot to improve gait and balance function among stroke survivors with chronic lower extremity hemiparesis. One approach uses the ankle robot in a seated visuomotor training program that focuses on improving paretic ankle motor control that may transfer to gait and balance functions. The other approach follows the dominant rehabilitation paradigm of task-specific training by integrating use of the ankle robot during treadmill exercise training to assess effects on the same outcomes. The effectiveness of both robotics approaches will be compared to that of a treadmill exercise program without robotics. The study tests the hypothesis that, in persons with chronic lower extremity hemiparesis, 6 weeks of seated ankle robot training will improve paretic ankle motor control with major improvements in standing balance and moderate improvements in gait, whereas the same amount of training on the treadmill with the ankle robot will improve gait function more than balance. Both robot-trained groups will outperform the treadmill only group on balance, while the treadmill + robot group will make the greatest gains in gait and the seated robot group will make some improvement in gait but will show greater gains in ankle motor control and balance. Aims: In a 6-week intervention (18 sessions) with persons with chronic lower extremity hemiparesis 1) Compare effects of seated visuomotor ankle robot training vs. treadmill + robot training on paretic ankle impairments and motor control; 2) Compare effects of seated-robot vs. treadmill + robot training on functional mobility and balance outcomes; and 3) Compare the effectiveness of both robotics approaches to a standard treadmill exercise protocol of the same duration. This proposal will establish the initial comparative efficacy of two motor learning based approaches using a modular impedance controlled ankle robot and contrast motor control and functional gait and balance outcomes among them. As a pilot study we will establish initial deficit profiles for users that respond to each intervention across the 6-week period. This will begin to fill the knowledge gap on how to apply robotics technologies in the elderly stroke population. Such findings have the potential to change the paradigm of stroke care based upon advances in our understandings of activity-dependent brain plasticity and the critical need for improving mobility in the rehabilitation of Veterans and others with disabilities. Our results will provide the requisite information to design a larger Merit Award trial that refines or combines these interventions to reduce risk factors for disabilities and limited social participation in the growing stroke population. PUBLIC HEALTH RELEVANCE: Relevance of the Proposed Work to the VA Health Care Mission The VA patient care mission seeks to improve the general health status and quality of life of Veterans after disabling diseases such as stroke. Using a novel ankle robotics device, this study tests two new approaches aimed at improving gait and balance function after a stroke. In one approach subjects use the robot to play ankle videogames and the other uses the robot while walking on a treadmill. The goal is to re-learn motor control of the weaker ankle to improve gait and balance. These approaches may eventually help in other neurologic disabilities, including neurologic injuries among returning Veterans from recent wars. Generally, such uses of robotics may help to reshape rehabilitation models within the VA by augmenting the effectiveness and scope of therapy by allowing longer training sessions, facilitating more intensive sessions, and enabling therapists to work with larger numbers of VA patients at a given time.