Name: functional mri in conjunction with a novel mri-compatible hand-induced robotic device to evaluate rehabilitation of individuals recovering from hand grip deficits
Uploaded: 2019-11-23T12:30:00
Description: Watch this Scientific Journal Video about Functional MRI in Conjunction with a Novel MRI-compatible Hand-induced Robotic Device to Evaluate Rehabilitation of Individuals Recovering from Hand Grip Defi

This work was supported by a grant from the National Institute of Neurological Disorders and Stroke (Grant number 1R01NS105875-01A1) of the National Institutes of Health to A. Aria Tzika. This work was performed at the Athinoula A. Martinos Center for Biomedical Imaging.&#160; We wish to thank Director Dr. Bruce R. Rosen, M.D., Ph.D. and members of the Martinos Center staff for their support.&#160; We further wish to thank Mr. Christian Pusatere and Mr. Michael Armanini for their assistance in running experiments.&#160; Lastly, we thank Dr. Michael A. Moskowitz and Dr. Rosen for their guidance in the conception and development of the MR_CHIROD series of devices and the associated stroke studies.&#160;

All experiments were approved by the Institutional Review Board at Massachusetts General Hospital and performed as approved at the Athinoula A. Martinos Center for Biomedical Imaging.
1. Subject Preparation
NOTE: Inclusion criteria are: (i) right hand dominance, (ii) ability to give written informed consent. Exclusion was implemented on the basis of screening for contra-indicators in the magnetic resonance environment such as the following: (a) Routin...

<ol>
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H., Kateb, B., Tzika, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+MRI+using+robotic+MRI+compatible+devices+for+monitoring+rehabilitation+from+chronic+stroke+in+the+molecular+medicine+era+(Review).">Functional MRI using robotic MRI compatible devices for monitoring rehabilitation from chronic stroke in the molecular medicine era (Review).</a> IEEE International Journal of Molecular Medicine. 29 (6), 963-973 (2012).</li><li>Lazaridou, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=fMRI+as+a+molecular+imaging+procedure+for+the+functional+reorganization+of+motor+systems+in+chronic+stroke.">fMRI as a molecular imaging procedure for the functional reorganization of motor systems in chronic stroke.</a> Molecular Medicine Reports. 8 (3), 775-779 (2013).</li><li>Lazaridou, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+and+volumetric+magnetic+resonance+imaging+using+an+MR-compatible+hand-induced+robotic+device+suggests+training-induced+neuroplasticity+in+patients+with+chronic+stroke.">Diffusion tensor and volumetric magnetic resonance imaging using an MR-compatible hand-induced robotic device suggests training-induced neuroplasticity in patients with chronic stroke.</a> International Journal of Molecular Medicine. 32 (5), 995-1000 (2013).</li><li>Mintzopoulos, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Connectivity+alterations+assessed+by+combining+fMRI+and+MR-compatible+hand+robots+in+chronic+stroke.">Connectivity alterations assessed by combining fMRI and MR-compatible hand robots in chronic stroke.</a> NeuroImage. 47, T90-T97 (2009).</li><li>Mintzopoulos, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=fMRI+Using+GRAPPA+EPI+with+High+Spatial+Resolution+Improves+BOLD+Signal+Detection+at+3T.">fMRI Using GRAPPA EPI with High Spatial Resolution Improves BOLD Signal Detection at 3T.</a> The Open Magnetic Resonance Journal. 2, 57-70 (2009).</li><li>Khanicheh, A., Mintzopoulos, D., Weinberg, B., Tzika, A. A., Mavroidis, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+Electrorheological+Fluid+Dampers+for+Applications+at+3-Tesla+MRI+Environment.">Evaluation of Electrorheological Fluid Dampers for Applications at 3-Tesla MRI Environment.</a> IEEE/ASME Transactions on Mechatronics. 13 (3), 286-294 (2008).</li><li>Babaiasl, M., Mahdioun, S. H., Jaryani, P., Yazdani, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+technological+and+clinical+aspects+of+robot-aided+rehabilitation+of+upper-extremity+after+stroke.">A review of technological and clinical aspects of robot-aided rehabilitation of upper-extremity after stroke.</a> Disability and Rehabilitation Assistive Technology. 11 (4), 263-280 (2016).</li><li>Huang, V. S., Krakauer, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+neurorehabilitation:+a+computational+motor+learning+perspective.">Robotic neurorehabilitation: a computational motor learning perspective.</a> Journal of NeuroEngineering and Rehabilitation. 6, 5 (2009).</li><li>Tsekos, N., Khanicheh, A., Christoforou, E., Mavroidis, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+Resonance-Compatible+Robotic+and+Mechatronics+Systems+for+Image-Guided+Interventions+and+Rehabilitation:+A+Review+Study.">Magnetic Resonance-Compatible Robotic and Mechatronics Systems for Image-Guided Interventions and Rehabilitation: A Review Study.</a> Annual Review of Biomedical Engineering. 9, 351-387 (2007).</li><li>Sivak, M., Unluhisarcikli, O., Weinberg, B., Mirelman-Harari, A., Bonato, P., Mavroidis, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Haptic+system+for+hand+rehabilitation+integrating+an+interactive+game+with+an+advanced+robotic+device.">Haptic system for hand rehabilitation integrating an interactive game with an advanced robotic device.</a> Proceedings of IEEE Haptics Symposium. , (2010).</li><li>Colombo, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Design+strategies+to+improve+patient+motivation+during+robot-aided+rehabilitation.">Design strategies to improve patient motivation during robot-aided rehabilitation.</a> Journal of NeuroEngineering and Rehabilitation. 4 (1), 3 (2007).</li><li>Unluhisarcikli, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Robotic+Hand+Rehabilitation+System+with+Interactive+Gaming+Using+Novel+Electro-Rheological+Fluid+Based+Actuators.">A Robotic Hand Rehabilitation System with Interactive Gaming Using Novel Electro-Rheological Fluid Based Actuators.</a> Proceedings of IEEE International Conference on Robotics and Automation. , (2010).</li></ol>

We present fMRI of a motor task using the latest version of a novel robotic device, the MR_CHIROD1,2,8. The MR_CHIROD has been designed to execute a hand-squeezing grip task which has can be performed by chronic stroke patients and has been studied previously1,2,3,4,5...

Appropriate imaging metrics may monitor and predict the likelihood of therapy success in individuals better than clinical assessments and provide information to improve and individualize therapy planning. We have developed experience with patients recovering from chronic stroke1,2,3,4,5,6,7,8. Developing optimal individualized strategies that focus on how motor training can influence incremental improvement either in reorganization of neural activity and/or motor function is still challenging. Insights into the underlying structural remodeling and re-organization processes for functional recovery in the brain after neurological disease can allow us to evaluate the relationship between distributed topographic patterns of neural activity and functional recovery via functional neuroimaging methods and brain mapping. Success will facilitate developing personalized treatment strategies optimized to yield improvements in grip strength in broad population with neurological conditions based on magnetic resonance imaging (MRI) metrics9.
Here we present a protocol that employs a newly re-designed robotic hand device that provides a controllable resistance force against which a subject grips and releases a handle in synchrony with an oscillating visual stimulus. The MR_CHIROD v3 (MR-compatible Hand-Induced RObotic Device) is a system for presentation of adjustable forces against which gripping and releasing motions are performed, while measuring and recording applied force, grip displacement and timestamps for each data point (Figure 1). The device was engineered to provide reliable assessments of brain activation images during fMRI (functional Magnetic Resonance Imaging), which can be used to evaluate blood-oxygen-level dependent (BOLD) changes in brain responses of patients recovering from neurological disorders. MR-compatibility is achieved through the use of entirely non-ferrous/non-magnetic components for the structure and pneumatic actuator elements and shielded sensor/electronic components that are positioned on the scanner&#8217;s bed. Figure 2 shows the device attached to an MR scanner bed, and with a subject in the magnet bore grasping the handle of the MR_CHIROD v3 (Figure 3). Interface and control components are positioned outside the MR scanner room (Figure 4).
The device is used simultaneously with brain imaging methods to assess relevant brain activations. The primary use of the system is to provide a motor task that generates activations of the brain&#39;s motor areas, which are detected using fMRI. Brain activation while using the MR_CHIROD during imaging can assess neuroplasticity in neurological disease. By tracking changes in activations in the course of and after motor training using the MR_CHIROD, progress of motor rehabilitation following any neurological disease that leads to motor deficits (e.g., stroke) may be observed.
The MR_CHIROD v3 can also be table-mounted, for use in intra-scan training exercises, in which the subject grips and releases in response to suitable visual stimuli for periods of 45 min, three times per week during the study. Our experience with robotically delivered training, monitored with imaging, suggests that the recovery window for stroke patients for instance may never close1.
Our rationale for building and using an MR-compatible hand-grip robot is that robotic recovery has the potential to produce a great impact on impairment due to its easy deployment, applicability across various motor impairments, high measurement reliability, and capacity to deliver high intensity training protocols10. Our MR-compatible robot can: (a) be set for subject-specific ranges of motion and be programmatically adjusted to apply subject-specific force levels; (b) control, measure and record force and displacement parameters through a host computer; (c) remotely adjust control parameters without requiring interruption of scanning for access to the MR scanner room or repositioning of the subject; and (d) provide therapy via training exercises precisely and consistently for extended periods.
We are aware of no commercially available recovery robotic device that can be used with an MR scanner to measure the subject&#8217;s hand grip force and displacement while applying computer-controlled time-varying force. Tsekos et al.11 have reviewed a variety of primarily research-based, MR-compatible robotic and rehabilitation devices, including earlier iterations of the MR_CHIROD series of devices. Other devices were designed for studying wrist motion, finger motion, isometric grip strength, and multi-joint movements. For devices that actively provide resistive or other forces, a variety of MR-compatible technologies have been employed including hydraulics, pneumatics, mechanical linkages and electrorheological fluid dampers. Some devices include multiple degrees of freedom, including another extension of the earlier MR_CHIROD versions added a rotational degree of freedom and hydraulic force application, however it was not adapted for MR-compatibility12.
Our hand-grip-specific device has the advantages of portability (it is regularly transported between the MR facility and office-based training sites), and capability of producing large, computer-controlled, time-varying resistive forces. Current use of pneumatic technology in the MR_CHIROD avoids the need for high voltage sources necessary for electro-rheological fluid-based systems, the potential for leakage of hydraulic fluid, and complex cable/linkages linking the interface mechanism with external power and control components.
The MR_CHIROD was the first device that was demonstrated to function in conjunction with fMRI for brain mapping in stroke patients1. Importantly, the MR_CHIROD v3 is particularly useful for home- or office-based training, as the system and its software were designed for use without expert clinical support and with motivational elements (&#8220;gamification&#8221;). Relative to physical therapist-facilitated training in a hospital, office- or home-based training is less expensive and more convenient, making it easier for patients to adhere to daily therapy. The device, already relatively inexpensive relative to some of the other research-based devices, can be reengineered to improve the cost-to-benefit ratio. Virtual reality and gamification of training, both of which are compatible with the MR_CHIROD v3, can engage patients, increase their attention during the task, and improve motivation, thus increasing the effectiveness of recovery13.

<table>
	<tbody>
		<tr>
			<td>Ball bearings, plastic with glass balls (8)</td>
			<td>McMaster-Carr</td>
			<td>6455K97</td>
			<td></td>
		</tr>
		<tr>
			<td>Bi-directional logic level converter</td>
			<td>Adafruit</td>
			<td>395</td>
			<td></td>
		</tr>
		<tr>
			<td>Dual LS7366R Quadrature Encoder Buffer</td>
			<td>SuperDroid Robots</td>
			<td>TE-183-002</td>
			<td></td>
		</tr>
		<tr>
			<td>Feather M0 WiFi w/ATWINC1500</td>
			<td>Adafruit</td>
			<td>Adafruit 3010</td>
			<td></td>
		</tr>
		<tr>
			<td>Flanged nuts, fiberglass, 3/8&#8221;-16 (8)</td>
			<td>McMaster-Carr</td>
			<td>98945A041</td>
			<td></td>
		</tr>
		<tr>
			<td>Garolite rod, &#190;&#8221; dia, 4&#8217; long</td>
			<td>McMaster-Carr</td>
			<td>8467K84</td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop</td>
			<td>Various</td>
			<td></td>
			<td>Any laptop with USB2.0 port(s) and MATLAB</td>
		</tr>
		<tr>
			<td>Load Cell (20kg)</td>
			<td>Robotshop</td>
			<td>RB-PHI-119</td>
			<td></td>
		</tr>
		<tr>
			<td>Load Cell Amplifier- HX711</td>
			<td>Mouser</td>
			<td>474-SEN-13879</td>
			<td></td>
		</tr>
		<tr>
			<td>MATLAB</td>
			<td>MathWorks</td>
			<td></td>
			<td>2008 version or later with Psychophysics Toolbox</td>
		</tr>
		<tr>
			<td>Magnetic resonance imaging scanner</td>
			<td>Siemens</td>
			<td>Skyra 3T</td>
			<td>3T full body scanner with BOLD and GRAPPA capabilities</td>
		</tr>
		<tr>
			<td>MR_CHIRODv3</td>
			<td>fabricated in-house</td>
			<td></td>
			<td>Bespoke plastic &#38; 3D printed structure</td>
		</tr>
		<tr>
			<td>Op amp development board</td>
			<td>Schmartboard</td>
			<td>710-0011-01</td>
			<td></td>
		</tr>
		<tr>
			<td>Panel Mount Power Supply</td>
			<td>Delta</td>
			<td>PMT-D2V100W1AA</td>
			<td></td>
		</tr>
		<tr>
			<td>Plastic tubing &#38; tube fittings</td>
			<td>McMaster-Carr</td>
			<td>various</td>
			<td></td>
		</tr>
		<tr>
			<td>Pyrex/graphite piston/cylinder module</td>
			<td>Airpot</td>
			<td>2KS240-3</td>
			<td></td>
		</tr>
		<tr>
			<td>Screws, &#188;&#8221;-20, nylon</td>
			<td>McMaster-Carr</td>
			<td>various</td>
			<td></td>
		</tr>
		<tr>
			<td>Shaft Collars for &#190;&#8221; dia shaft, nylon (2)</td>
			<td>McMaster-Carr</td>
			<td>9410T6</td>
			<td>Stock metal clamping screws replaced with plastic screws</td>
		</tr>
		<tr>
			<td>Shielded cables (2)</td>
			<td>US Digital</td>
			<td>CA-C5-SH-C5-25</td>
			<td></td>
		</tr>
		<tr>
			<td>Threaded rod, fiberglass, 3/8&#8221;-16</td>
			<td>McMaster-Carr</td>
			<td>91315A010</td>
			<td></td>
		</tr>
		<tr>
			<td>Transmissive optical encoder code strip</td>
			<td>US Digital</td>
			<td>LIN-2000-3.5-0.5</td>
			<td></td>
		</tr>
		<tr>
			<td>Transmissive Optical Encoder Module</td>
			<td>US Digital</td>
			<td>EM2-0-2000-I</td>
			<td></td>
		</tr>
		<tr>
			<td>PTFE sleeve bearings</td>
			<td>McMaster-Carr</td>
			<td>2639T32</td>
			<td></td>
		</tr>
	</tbody>
</table>

functional mri in conjunction with a novel mri-compatible hand-induced robotic device to evaluate rehabilitation of individuals recovering from hand grip deficits

Functional magnetic resonance imaging (fMRI) is a non-invasive magnetic resonance imaging technique that images brain activation in vivo, using endogenous deoxyhemoglobin as an endogenous contrast agent to detect changes in blood-level-dependent oxygenation (BOLD effect). We combined fMRI with a novel robotic device (MR-compatible hand-induced robotic device [MR_CHIROD]) so that a person in the scanner can execute a controlled motor task, hand-squeezing, which is a very important hand movement to study in neurological motor disease. We employed parallel imaging (generalized auto-calibrating partially parallel acquisitions [GRAPPA]), which allowed higher spatial resolution resulting in increased sensitivity to BOLD. The combination of fMRI with the hand-induced robotic device allowed precise control and monitoring of the task that was executed while a participant was in the scanner; this may prove to be of utility in rehabilitation of hand motor function in patients recovering from neurological deficits (e.g., stroke). Here we outline the protocol for using the current prototype of the MR_CHIROD during an fMRI scan.

The methodology outlined in the protocol allows the collection of fMRI images while the volunteer is performing the task in real-time in the magnet. Experiments were performed in the Bay 1 facility of the Massachusetts General Hospital Athinoula A. Martinos Center for Biomedical Imaging, using a 3T full-body magnetic resonance scanner. Figure 2 and Figure 3 show the placement of the MR_CHIROD on the table and the patient in place operating it. In <strong class="...

Watch this Scientific Journal Video about Functional MRI in Conjunction with a Novel MRI-compatible Hand-induced Robotic Device to Evaluate Rehabilitation of Individuals Recovering from Hand Grip Defi

Functional MRI in Conjunction with a Novel MRI-compatible Hand-induced Robotic Device to Evaluate Rehabilitation of Individuals Recovering from Hand Grip Deficits

We performed functional MRI using a novel MRI-compatible hand-induced robotic device to evaluate its utility for monitoring hand motor function in individuals recovering from neurological deficits.

Functional magnetic resonance imaging (fMRI) is a non-invasive magnetic resonance imaging technique that images brain activation in vivo, using endogenous ...

This protocol is used to monitor the rehabilitation of patients with hand grip deficits. Chronic stroke patients and those with other neurological diseases involving motor deficits may benefit from this technique. Magnetic Resonance Imaging allows monitoring of the adaptability of the brain.In other words, neuroplasticity in response to rehabilitation of grip performance. With suitable modification of the force stimulus device this method can be applied for rehabilitation of disabilities affecting other regions of the body. This device, and any modifications, must retain MR compatibility.It's important to insure that the MRI rod has been properly connected and it's functions verified before bringing a subject into the MR room. Prior to starting this experiment first obtain informed consent from the subject and thoroughly screen them for MRI safety. Do not proceed with the scan if the participant has any potential MRI contraindications.To begin setup, first bring the magnetic resonance compatible hand induced robotic device into the MRI room and place it near the penetration panel. Then, insert the 3/8 inch pneumatic tube into the pass through tube in the panel, into the adjacent MRI support room. Then, connect the support room fore sensing and encoder cables to the D-sub connector on the external side of the penetration panel as shown here.Connect the 3/8 inch pneumatic tube fitting, emerging from the penetration panel, to the outlet of the interface power unit pressure regulator outlet. Then, connect the four millimeter pneumatic tube to the outlet of the compressor in the inlet of the air filter on the interface power regulator. After extending and lowering the scanner bed attach the bottom half of the head coil and have the volunteer lay down, making sure that they are resting comfortably with their arms extended and use small foam pads to immobilize the participant's head.Attach the communication ball on the volunteer's chest and provide instructions on its use. Also, attach the top of the head coil. Now, loosely install the robotic device on the side of the patient opposite to their brain lesion using the corresponding bed slot.Then, with the volunteer's elbow resting on the table to support their arm, move the device handle to the webbing between thumb and forefinger and help them grab the handles. If the device is on the opposite side of the table from the penetration panel position the cables in the pneumatic tube so that they pass under the table rather than over the patient. Next, instruct the volunteer to squeeze and push or pull the device until they have the most comfortable position for squeezing.Then secure the device firmly in place by tightening the plastic nuts using an MR compatible wrench. Now, run the custom user interface stimulus program. Set the pressure to the minimal set-up level to automatically push the handle to the end stop, verifying display of motion and force waveforms.Next, set the force level and instruct the volunteer to completely squeeze two to three times for approximately two seconds. Observe whether the volunteer can complete a squeeze at that force level. Gradually increase the force level and repeat squeeze attempts until they cannot complete a squeeze.This measurement serves as the volunteer's maximum grip strength. The program will automatically calculate 60%40%and 20%of the maximum force level for use during testing. Next, confirm that the communication ball works, then position using the laser alignment, before moving the table and the participant into the scanner's iso center.Now, using the user interface, generate the instruction and stimulus images and set the system to apply the first force level and wait for a trigger signal from the MRI scanner. The program will display a set of instructions to remind the volunteer how to respond to the visual stimulus. The program will wait for the scanner to provide a trigger signal then remove the instructions and show a fixation cross that the volunteer should focus on.When the fMRI scan acquisition begins a visual metronome will be displayed in the form of a growing and shrinking circle. The volunteer should completely squeeze and release the handle synchronously with the stimulus. Rest periods will separate stimulus periods during which time the fixation cross will again be displayed.Observe the live plots of force and displacement to monitor the force output and participant task performance. Once the experiment is complete let the participant know they can relax and to let go of the handle. Finally, collect a series of anatomical scans.This figure shows typical motor task results. Here we see fMRI activations superimposed on a brain outline and as pseudo-color on a three dimensional, cross-sectional view of the volunteer's anatomical image. M1 indicates the primary motor cortex and SMA indicates the supplementary motor area.This image shows pseudo-color activations rendered on a brain template. This graph shows actual force output measured in units of force as a function of time. The output was recorded in real time.The white bar corresponds with the 60-second stimulus and rest period. Here, a single voxal time course of activation is shown, chosen from a voxal at the somatosensory area at the location of the cross-hairs in this image. All subjects must be properly trained in performing the metronome tracking grip motions in advance.In addition, synchronization between the visual stimulus and the MRI sequence is crucial. Additional imaging modalities can be used in this protocol, including Diffusion Tensor Imaging to detect white matter fiber tract orientation and growth, which is also expected to change with rehabilitation. Performing any MR experiment is hazardous due to the powerful magnetic field generated by the scanner.Therefore, all subjects and experimenters must follow MR safety guidelines including screening for contraindications. Development of this process will allow the demonstration that stroke recovery continues beyond six months post-injury suggesting that therapy and associated insurance reimbursement should continue beyond this time.

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