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Lancet：瘫痪患者通过颅内电极控制假肢

2012-12-19 Lancet Lancet

瘫痪假肢截肢
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　　 　　瘫痪或者肢体的截肢会导致手部指向，抓持，操作和移动物体功能的丧失，而这些功能都是日常生活中所必须。脑-机接口可以为这些丧失功能的人群提供一种解决方案。日前，来自美国匹兹堡老兵医学（VeteranAffair）中心，匹兹堡医学中心（UPMC）康复科，和匹兹堡大学生物医学工程系的Jennifer L Collinger PhD实现了这一梦想（查看视频）。他通过

　　瘫痪

　　瘫痪或者肢体的截肢会导致手部指向，抓持，操作和移动物体功能的丧失，而这些功能都是日常生活中所必须。脑-机接口可以为这些丧失功能的人群提供一种解决方案。日前，来自美国匹兹堡老兵医学（VeteranAffair）中心，匹兹堡医学中心（UPMC）康复科，和匹兹堡大学生物医学工程系的Jennifer L Collinger PhD实现了这一梦想（查看视频）。他通过在一位四肢瘫痪患者皮质内植入电极，利用神经生物学方法控制高性能假肢，这种假肢可以自由实现各种空间活动。这些研究在线发表在最新一期的Lancet首页上。

　　研究者在一位52岁四肢瘫痪的患者脑皮质区植入了两个96-通道的皮质区微电极。通过在这个参与者的假肢上实现七个自由度的活动（三维的平移，三维的旋转和一维的抓持）来对其进行评估。整个试验进行了13周。通过临床方法评估参与者控制假肢，进行上肢活动的能力。这项研究在ClinicalTrials.gov进行了注册，注册号是NCT01364480。

　　参与者在训练的第二天就能够顺利的利用假肢在三维空间内进行活动。在13周后，七个维度的活动可以常规顺利完成。按照目标-界定完成的任务成功率是91.6%（标准差4.4）vs中位成功率 6.2%（95%置信区间2.0-15.3）。完成时间也得到了改善（从平均的148s[SD 60]下降到了112s并且寻路效率（从0.30 [0·04] 上升到了 0·38 [0·02]）。参与者同时可以熟练利用假肢进行协调及抓持动作，在上肢功能上可以获得明显的临床收益。尚未报道任何不良反应。

　　随着神经假肢领域的进展，患有长期瘫痪的个体可以通过自然而直观的命令信号来进行假肢手平移活动，旋转及触及等活动，可以通过这些活动来实现日常生活自理。

与瘫痪相关的拓展阅读：


Background
Paralysis or amputation of an arm results in the loss of the ability to orient the hand and grasp, manipulate, and carry objects, functions that are essential for activities of daily living. Brain—machine interfaces could provide a solution to restoring many of these lost functions. We therefore tested whether an individual with tetraplegia could rapidly achieve neurological control of a high-performance prosthetic limb using this type of an interface.
Methods
We implanted two 96-channel intracortical microelectrodes in the motor cortex of a 52-year-old individual with tetraplegia. Brain—machine-interface training was done for 13 weeks with the goal of controlling an anthropomorphic prosthetic limb with seven degrees of freedom (three-dimensional translation, three-dimensional orientation, one-dimensional grasping). The participant's ability to control the prosthetic limb was assessed with clinical measures of upper limb function. This study is registered with ClinicalTrials.gov, NCT01364480.
Findings
The participant was able to move the prosthetic limb freely in the three-dimensional workspace on the second day of training. After 13 weeks, robust seven-dimensional movements were performed routinely. Mean success rate on target-based reaching tasks was 91·6% (SD 4·4) versus median chance level 6·2% (95% CI 2·0—15·3). Improvements were seen in completion time (decreased from a mean of 148 s [SD 60] to 112 s [6]) and path efficiency (increased from 0·30 [0·04] to 0·38 [0·02]). The participant was also able to use the prosthetic limb to do skilful and coordinated reach and grasp movements that resulted in clinically significant gains in tests of upper limb function. No adverse events were reported.
Interpretation
With continued development of neuroprosthetic limbs, individuals with long-term paralysis could recover the natural and intuitive command signals for hand placement, orientation, and reaching, allowing them to perform activities of daily living.
Funding
Defense Advanced Research Projects Agency, National Institutes of Health, Department of Veterans Affairs, and UPMC Rehabilitation Institute.
    

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    2012-12-21 howi

    #Lancet#

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    2012-12-21 ms1948154235210413

    #瘫痪#

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    2012-12-21 xlwang2695

    #假肢#

    0

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