Rice University, Deptartment of Mechanical Engineering, Houston, TX 77005, USA.
Cleveland State University, Center for Human-Machine Systems, Cleveland, OH 44115, USA; Cleveland Functional Electrical Stimulation Center, Cleveland, OH 44106, USA.
Exp Neurol. 2020 Jun;328:113274. doi: 10.1016/j.expneurol.2020.113274. Epub 2020 Mar 5.
Individuals with tetraplegia, typically attributed to spinal cord injuries (SCI) at the cervical level, experience significant health care costs and loss of independence due to their limited reaching and grasping capabilities. Neuromuscular electrical stimulation (NMES) is a promising intervention to restore arm and hand function because it activates a person's own paralyzed muscles; however, NMES sometimes lacks the accuracy and repeatability necessary to position the limb for functional tasks, and repeated muscle stimulation can lead to fatigue. Robotic devices have the potential to restore function when used as assistive devices to supplement or replace limited or lost function of the upper limb following SCI. Unfortunately, most robotic solutions are bulky or require significant power to operate, limiting their applicability to restore functional independence in a home environment. Combining NMES and robotic support systems into a single hybrid neuroprosthesis is compelling, since the robotic device can supplement the action of the muscles and improve repeatability and accuracy. Research groups have begun to explore applications of movement assistance for individuals with spinal cord injury using these technologies in concert. In this review, we present the state of the art in hybrid NMES-orthotic systems for upper limb movement restoration following spinal cord injury, and suggest areas for emphasis necessary to move the field forward. Currently, NMES-robotic systems use either surface or implanted electrodes to stimulate muscles, with rigid robotic supports holding the limb against gravity, or providing assistance in reaching movements. Usability of such systems outside of the lab or clinic is limited due to the complexity of both the mechanical components, stimulation systems, and human-machine interfaces. Assessment of system and participant performance is not reported in a standardized way. Future directions should address wearability through improvements in component technologies and user interfaces. Further, increased integration of the control action between NMES and robotic subsystems to reanimate the limb should be pursued. Standardized reporting of system performance and expanded clinical assessments of these systems are also needed. All of these advancements are critical to facilitate translation from lab to home.
四肢瘫痪患者，通常归因于颈部脊髓损伤 (SCI)，由于其有限的伸展和抓握能力，会经历高昂的医疗费用和丧失独立性。神经肌肉电刺激 (NMES) 是一种有前途的干预措施，可以恢复手臂和手部功能，因为它激活了人的自身瘫痪肌肉；然而，NMES 有时缺乏必要的准确性和可重复性，无法为功能任务定位肢体，并且重复的肌肉刺激会导致疲劳。机器人设备具有恢复功能的潜力，可作为辅助设备使用，以补充或替代 SCI 后上肢的有限或丧失功能。不幸的是，大多数机器人解决方案体积庞大或需要大量电力才能运行，限制了它们在家庭环境中恢复功能独立性的适用性。将 NMES 和机器人支持系统结合到单个混合神经假体中是很有吸引力的，因为机器人设备可以补充肌肉的作用，提高重复性和准确性。研究小组已经开始探索使用这些技术联合为脊髓损伤患者提供运动辅助的应用。在这篇综述中，我们介绍了用于脊髓损伤后上肢运动恢复的混合 NMES-矫形器系统的最新技术，并提出了推动该领域发展所需的重点领域。目前，NMES-机器人系统使用表面或植入电极来刺激肌肉，刚性机器人支撑物将肢体抵抗重力，或在伸展运动中提供辅助。由于机械部件、刺激系统和人机界面的复杂性，这些系统在实验室或诊所之外的可用性受到限制。系统和参与者性能的评估没有以标准化的方式报告。未来的方向应该通过改进组件技术和用户界面来解决可穿戴性问题。此外，应该进一步增加 NMES 和机器人子系统之间的控制动作的集成，以重新激活肢体。还需要报告系统性能的标准化和对这些系统的扩展临床评估。所有这些进展对于促进从实验室到家庭的转化都至关重要。
