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首页> 美国卫生研究院文献>Frontiers in Neuroscience >A Personalized Multi-Channel FES Controller Based on Muscle Synergies to Support Gait Rehabilitation after Stroke
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A Personalized Multi-Channel FES Controller Based on Muscle Synergies to Support Gait Rehabilitation after Stroke

机译：基于肌肉协同作用的个性化多通道FES控制器支持中风后步态康复

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It has been largely suggested in neuroscience literature that to generate a vast variety of movements, the Central Nervous System (CNS) recruits a reduced set of coordinated patterns of muscle activities, defined as muscle synergies. Recent neurophysiological studies have recommended the analysis of muscle synergies to finely assess the patient's impairment, to design personalized interventions based on the specific nature of the impairment, and to evaluate the treatment outcomes. In this scope, the aim of this study was to design a personalized multi-channel functional electrical stimulation (FES) controller for gait training, integrating three novel aspects: (1) the FES strategy was based on healthy muscle synergies in order to mimic the neural solutions adopted by the CNS to generate locomotion; (2) the FES strategy was personalized according to an initial locomotion assessment of the patient and was designed to specifically activate the impaired biomechanical functions; (3) the FES strategy was mapped accurately on the altered gait kinematics providing a maximal synchronization between patient's volitional gait and stimulation patterns. The novel intervention was tested on two chronic stroke patients. They underwent a 4-week intervention consisting of 30-min sessions of FES-supported treadmill walking three times per week. The two patients were characterized by a mild gait disability (walking speed > 0.8 m/s) at baseline. However, before treatment both patients presented only three independent muscle synergies during locomotion, resembling two different gait abnormalities. After treatment, the number of extracted synergies became four and they increased their resemblance with the physiological muscle synergies, which indicated a general improvement in muscle coordination. The originally merged synergies seemed to regain their distinct role in locomotion control. The treatment benefits were more evident for one patient, who achieved a clinically important change in dynamic balance (Mini-Best Test increased from 17 to 22) coupled with a very positive perceived treatment effect (GRC = 4). The treatment had started the neuro-motor relearning process also on the second subject, but twelve sessions were not enough to achieve clinically relevant improvements. This attempt to apply the novel theories of neuroscience research in stroke rehabilitation has provided promising results, and deserves to be further investigated in a larger clinical study.
机译：在神经科学文献中已大量提出，要产生各种各样的运动，中枢神经系统（CNS）会召集一组简化的肌肉活动协调模式，这被称为肌肉协同作用。最近的神经生理学研究建议对肌肉协同作用进行分析，以精确评估患者的损伤，根据损伤的具体性质设计个性化干预措施，并评估治疗效果。在此范围内，本研究的目的是设计一种用于步态训练的个性化多通道功能性电刺激（FES）控制器，该控制器整合了三个新颖的方面：（1）FES策略基于健康的肌肉协同作用，以模仿CNS产生运动的神经解决方案； （2）FES策略是根据患者的初始运动评估而个性化的，旨在专门激活受损的生物力学功能； （3）FES策略准确地映射在改变后的步态运动学上，从而在患者的步态和刺激模式之间实现最大程度的同步。该新型干预措施已在两名慢性卒中患者中进行了测试。他们接受了为期4周的干预，包括30分钟的FES支持的跑步机，每周行走3次。两名患者的特征是基线时有轻度步态障碍（步行速度> 0.8 m / s）。然而，在治疗之前，两名患者在运动过程中仅表现出三个独立的肌肉协同作用，类似于两个不同的步态异常。治疗后，提取的协同作用数量变为四个，并且它们与生理性肌肉协同作用的相似性增加，表明肌肉协调性普遍改善。最初合并的协同作用似乎恢复了它们在运动控制中的独特作用。对于一位患者，其治疗效果更为明显，他的动态平衡发生了重要的临床改变（Mini-Best测试从17增加到22），并且获得了非常积极的感知治疗效果（GRC = 4）。该治疗也对第二名受试者启动了神经运动再学习过程，但是十二个疗程不足以实现临床相关的改善。这种将神经科学研究的新颖理论应用于中风康复的尝试提供了可喜的结果，值得在更大的临床研究中进一步研究。

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