JP6536870B2 - Rehabilitation system and control method of rehabilitation system - Google Patents

Description

  The present invention relates to a rehabilitation system for stimulating a patient based on an electroencephalogram, and a control method of the rehabilitation system.

  Conventionally, in order to recover a patient who has caused paralysis in a limb due to a stroke or the like, there is known rehabilitation that operates the limb based on electroencephalogram. In this rehabilitation, the body drive is adapted to changes in the electroencephalogram that appear based on the expression of the movement intention that the patient tries to operate the limbs, for example, event-related desynchronization (ERD). It is known that the effect of rehabilitation is enhanced by using the body to operate the limb (for example, Non-Patent Document 1).

  The rehabilitation system of Patent Document 1 includes an electroencephalogram measurement device that measures a patient's electroencephalogram, a body drive device that operates the limbs, and a control device that controls these devices. The control device detects the ERD by the electroencephalogram measurement device as an expression of exercise intention, and drives the body drive device based on the detected ERD.

JP, 2012-217721, A

Shindo K, Kawashima K, Ushiba J, Ota N, Ito M, Ota T, Kimura A, Liu M, "Effects of Neurofeedback training with an electroencephalogram-based brain-computer interface for hand paralysis in patients with chronic stroke: a case series study ”, Journal of Rehabilitation Medicine 2011, Vol. 43, pp 951-957

The progress of training by the above-mentioned rehabilitation is characterized in that the individual difference between patients is large. Even if training is conducted according to the same procedure, some patients may proceed with training early, while others may take longer to train. This is a difference caused by the degree of plasticity and injury in the brain of each patient. Originally, it is desirable to change the training procedure according to the plasticity of the patient, but until now, after carrying out one course of training, additional training is given to patients whose recovery is not good. The measures were taken after the result of the training was understood to some extent.
However, the speed of recovery in rehabilitation is characterized in that the plasticity of the brain remains most immediately after the occurrence of the disorder and recovery is quick, and the rate of recovery decreases with the passage of time. Therefore, it is expected that the rehabilitation effect will be improved if the training procedure is adjusted for each patient by estimating the degree of plasticity of the brain before starting rehabilitation training.

  An object of the present invention is to provide a rehabilitation system and a control method of the rehabilitation system focusing on the degree of plasticity of the brain for each patient.

[1] A rehabilitation system according to an embodiment of the present invention comprises an electroencephalogram measurement device for measuring a patient's electroencephalogram, a presentation device for presenting information and feedback to the patient, and an electric device attached to the patient's body. A motor-driven brace that mechanically stimulates, and a signal related to the movement intention are extracted from the electroencephalogram measured by the electroencephalogram measurement device, and it is determined that the movement intention is correctly represented, the presentation device and the motorization It is a rehabilitation system provided with a control device which gives feedback from a brace, and the control device determines training amount so that training according to a degree of plasticity is carried out from an analysis result of an electroencephalogram before training.

[2] A control method of a rehabilitation system according to an aspect of the present invention includes the steps of: a control unit executing a process of analyzing the pre-training electroencephalogram measured by the electroencephalogram measurement apparatus; The controller performs a process of determining the amount of training so that training according to the degree of exercise is performed, and a presentation device for presenting information in the training based on the determined amount of training; The control device executes a process of controlling at least one of a stimulation and a mechanical stimulation that outputs at least one of mechanical stimulation.

  According to the rehabilitation system and the control method of the rehabilitation system, it is possible to provide a rehabilitation system focusing on the degree of plasticity of the brain for each patient.

The front view of the rehabilitation system of embodiment. The block diagram of the rehabilitation system of embodiment. The schematic diagram which shows the content displayed on a resting period on the image display part of embodiment. The figure explaining repetition of the training sequence of an embodiment. FIG. 7 is a schematic view showing the content displayed in the image period on the image display unit of the embodiment. The flowchart which shows the process sequence of the schedule determination process performed by the control apparatus of embodiment. Block diagram of a conventional rehabilitation system.

  As shown in FIG. 1, the rehabilitation system 1 includes an electroencephalogram measurement device 10, a presentation device 20, an electric brace 30, an operation unit 40, and a control device 50. The operation of each component of the rehabilitation system 1 will be described below with reference to FIGS. 1 and 2.

As shown in FIG. 1, the electroencephalogram measurement apparatus 10 has a headphone shape to be attached to the head of a patient, and includes a plurality of electrodes 11, an electroencephalogram measurement unit 12, and an electroencephalogram transmission unit 13.
The plurality of electrodes 11 are disposed at positions where it is easy to measure an electroencephalogram related to a patient's exercise intention when the patient wears the electroencephalogram measurement apparatus 10 on the head. Specifically, the plurality of electrodes 11 may correspond to, for example, a left motor area that controls the voluntary movement of the patient's right body and a position where the voluntary movement of the patient's left body can correspond to each of the right In the international 10-20 method, which is a designation method, it is preferable to place at the position of C4, C3). The same rehabilitation system 1 can be used for both patients with left hemiplegia and for patients with right hemiplegia by correlating the arrangement of the electrodes 11 with each of the left and right motor areas. From the viewpoint of weight reduction, easy mounting, etc., a headset may be used in which the electrode 11 is mounted only on one side of the exercise field.

The electroencephalogram measurement unit 12 amplifies the potential difference between two of the electrodes 11 and measures it as an electroencephalogram signal. The measured electroencephalogram is sent to the electroencephalogram transmission unit 13.
The electroencephalogram transmission unit 13 transmits the electroencephalogram signal measured by the electroencephalogram measurement unit 12 to the electroencephalogram reception unit 51 of the control device 50.

  The presentation device 20 includes a speaker 21 and an image display unit 22. The speaker 21 presents sound and voice to the patient based on the acoustic signal input from the control device 50. The image display unit 22 presents visual information to the patient based on the control signal supplied from the control device 50. The information presented to the patient includes instruction information on an instruction on what the patient should do, and feedback information on whether the patient can image as instructed.

  The motorized brace 30 comprises a brace 31 attached to the patient's finger and arm, a motor 32 and a muscle stimulation electrode 33. The motor 32 is attached near the elbow of the brace 31. The output shaft of the motor 32 and the spine of the finger of the appliance 31 are connected by a wire not shown. For this reason, when the motor 32 rotates, the finger of the patient wearing the appliance 31 is pulled by the wire to give a mechanical stimulus to the finger. This passively moves the patient's finger.

  The muscle stimulation electrode 33 is an electrode for applying muscle stimulation to the forearm of the patient. The muscle stimulation electrode 33 provides electrical stimulation to the forearm of the patient by current control between the electrodes 33 by the muscle stimulation control unit 59 (see FIG. 2) of the control device 50 controlled based on the timing of ERD detection. This electrical stimulation is the muscle stimulation of the patient's forearm. Emotional movements associated with muscle stimulation and control of the motor 32 provide feedback to the patient's somatic sensation.

  The operation unit 40 is configured as, for example, a mouse or a touch panel. An assistant of rehabilitation, for example, an occupational therapist, registers various information related to the patient in the control device 50 via the operation unit 40, and inputs an instruction to start or stop training on the control device 50. When the operation unit 40 is configured as a touch panel, it can be integrated with the presentation device 20.

The control device 50 will be described with reference to FIG.
The control device 50 includes an electroencephalogram reception unit 51, an ERD detection unit 52, a training control unit 53, a schedule determination unit 54, a frequency analysis unit 55, a feedback control unit 56, a presentation control unit 57, a motor control unit 58, and muscle stimulation control. A section 59 is provided.

  The control device 50 causes the patient to execute the training of alternately performing the resting state and the expression of the exercise intention at predetermined time intervals by the operation from the operation unit 40 and the control to the presentation device 20 and the electric brace 30. .

  The training of the rehabilitation training control unit 53 is started by a start instruction from the operation unit 40. A start instruction is input from the operation unit 40 to the training control unit 53 by the operation of the occupational therapist, and a series of training processes are performed.

Figure 3 shows the process chart of rehabilitation training.
One training (hereinafter, “training sequence”) includes a resting period and an image period for expressing exercise intention. During the resting period, the patient is required to relax and not recall specific thoughts. On the other hand, in the image period, the patient is required to express exercise intention. The resting period and the length of the image period are set, for example, to 5 seconds each.

  And training progresses by performing a rest period and an exercise image period alternately. A training time of, for example, about 40 minutes is set per day, in which the control device 50 repeats the above training sequence a plurality of times. In other words, the training sequence is performed until the predetermined training time per day is over. For one patient, this training is performed for 10 days, for example, to provide rehabilitation training.

  The training control unit 53 shown in FIG. 2 transmits to the presentation control unit 57 the switching timing between the resting period and the motion image period. The presentation control unit 57 presents the timing to the patient via the image display unit 22 and the speaker 21.

  FIG. 4 shows an example of information displayed on the image display unit 22. As shown in FIG. In the image display unit 22, a resting period frame 23 indicating a resting period and an image period frame 24 indicating an image period are displayed side by side. The passage of time is indicated by the vertical line 25 moving from left to right with time. In addition, the contents of the request for the patient are also displayed in the message box 26. The message box 26 displays a message such as “Please relax” during the resting period. In addition, as shown in FIG. 5, the message box 26 displays a message such as "Please image" during the image period.

  In addition, the speaker 21 in the presentation device 20 illustrated in FIG. 1 may present different notification sounds at the start timing of the resting period and the start timing of the image period. For this reason, the patient can recognize the switching between the resting period and the image period acoustically.

Next, with reference to FIG. 2, electroencephalogram analysis for analysis of exercise intention during training and feedback of analysis results to the patient will be described.
The electroencephalogram receiving unit 51 receives the electroencephalogram from the electroencephalogram transmitting unit 13. At the same time, the brain wave training timing from the training control unit 53 is received. The electroencephalogram measurement apparatus 10 constantly measures the electroencephalogram during the training period. Therefore, by receiving the training timing, the electroencephalogram transmission unit 13 can extract the electroencephalogram of the resting period and the electroencephalogram of the image period, and can transmit the electroencephalogram signal to the electroencephalogram receiving unit 51.

  The ERD detection unit 52 detects an ERD signal which is a signal associated with exercise intention. The ERD is an electroencephalogram that changes due to the expression of exercise intention, and is considered to occur uniquely when the exercise intention is expressed. If the patient can correctly express the ERD, the ERD signal will not be detected during the resting period and the ERD signal will be detected during the image period.

  The ERD signal is obtained by temporal change of the frequency power of brain waves. If a change in frequency power around a specific frequency, for example 10 Hz, is continuously observed for a predetermined time in a predetermined time range, it is determined that the ERD signal is detected.

  If it is determined that the ERD signal is detected, feedback control unit 56 creates feedback information for the patient. The feedback information is displayed on the screen of the image display unit 22 via the presentation control unit 57 or presented to the speaker 21 as sound information.

Next, the operation during training will be further described using FIGS. 1, 4 and 5.
As shown in FIG. 1, one training sequence is started with the patient pinching the peg P over the attached finger of the power device 30. Therefore, when the ERD signal is detected, the finger is extended by the control of the motor 32 of the electric device 30, and the peg P falls. At this time, feedback from the muscle is given to the nerve function related to the extension of the finger, and recovery of the nerve function is promoted. Further, with the drive of the motor-driven brace 30, the muscle stimulation electrode 33 applies an electrical stimulation to the muscles involved in the extension of the finger, for example, the extensor digitus digitus generalis muscle. For this reason, muscle feedback is given to the nerve function related to the extension of the finger, and recovery of the nerve function is promoted.

  The control device 50 starts training control by the operation of the operation unit 40. The training control unit 53 sends an instruction to the presentation control unit 57 so that the training sequence of the resting period and the image period can be repeatedly presented. The presentation control unit 57 causes the image display unit 22 to display that a training is being performed by a graph or the like as shown in FIG. 4. At the start of the resting period and at the start of the image period, the presentation control unit 57 is made to create presentation information, and the speaker 21 is made to present a notification sound. The patient recognizes that it has shifted to the image period from at least one of the notification sound from the speaker 21 and the display content of the image display unit 22, and performs exercise intention expression. In the resting period and the image period, as shown in FIG. 5, the calculation result 28 of the ERD decay rate is continuously displayed by the graph, and the ERD is detected when the ERD decay rate is a certain value or more. The determination is made, and the time interval is additionally displayed as visual feedback information on the image display unit 22 as, for example, a band 27. In addition, the speaker 21 notifies that the ERD has been detected as auditory feedback information. Further, feedback is also performed from the electric device 30 by the motor control unit 58 and the muscle stimulation control unit 59.

  By these processes, when the patient expresses an exercise intention, it is possible to give feedback of somatic sensation artificially through the control device 50, and the experience that the body moves as expected is artificial. It will be possible. Rehabilitation is promoted by repeating this.

As mentioned above, training is implemented by the rehabilitation system.
Next, the characteristics of the patient the inventor of the present application has focused on will be described. The following references were focused on the degree of recovery of the patient's disorder.

“Westlake et al.“ Resting state alpha-band functional connectivity and recovery after stroke ”, Experimental Neurology 237 (2012) p160-169
According to the above-mentioned document, it has been described that the patient's MEG, in particular, the activity intensity of the alpha band (8 to 13 hertz) and the degree of recovery of the patient with ischemic stroke are related. Since it is considered that the plasticity of the brain is increased when the activity intensity of the α band is strong, and that the activity intensity of the α band can be estimated also by electroencephalogram, the inventors have made this finding in the rehabilitation system. Thought that it could be introduced.

  Specifically, the inventors conceived from this finding that adjusting the schedule of rehabilitation according to the activity intensity of the alpha band can contribute to the improvement of the effect of rehabilitation.

  The schedule determination unit 54 creates a rehabilitation schedule based on the activity intensity of the α band, and stores it in a memory (not shown) in the training control unit 53. The schedule is for several days. The schedule defines the time and the number of times to repeat the training sequence on each day. The training control unit 53 executes training control based on the schedule created by the schedule determination unit 54.

  The training control unit 53 reads the schedule from the memory before the start of rehabilitation each day. The training control unit 53 repeats the training sequence until the time determined by the schedule has elapsed. When the time determined by the schedule has passed, the training control unit 53 ends the training control and ends the rehabilitation on that day.

The training schedule determination process will be described with reference to FIG.
The schedule determination process is performed before the start of rehabilitation each day. The schedule determination process is performed in a state where the patient wears the electroencephalogram measurement apparatus 10 and the patient sits down in a chair or the like.

  In step S11, the control device 50 determines, based on a signal from the operation unit 40, whether or not the patient ID is registered. For example, when the occupational therapist does not register the patient ID, that is, when the operation to the first day of rehabilitation is performed, it is determined that the patient ID registration is not performed. In addition, when the occupational therapist registers the patient ID, that is, when the operation on the second day of rehabilitation is performed, it is determined that the patient ID is registered.

  When the control device 50 determines that the patient ID is not registered in step S11, the training control unit 53 creates the patient ID in step S12. Next, the frequency analysis unit 55 calculates the activity intensity of the α band from the electroencephalogram received by the electroencephalogram reception unit 51 based on the signal from the electroencephalogram measurement device 10 in step S13. Then, in step S14, the schedule determination unit 54 creates a rehabilitation schedule based on the activity intensity of the α band, and the training control unit 53 determines this schedule as the rehabilitation schedule.

  Specifically, the schedule determination unit 54 reads the schedule of the standard stored in advance, and when the activity intensity of the α band is lower than the threshold, at least one of the time of rehabilitation per day and the number of days of rehabilitation Create a schedule to be longer than the standard schedule. The training control unit 53 associates the schedule determined by the schedule determination unit 54 with the patient ID and stores the associated schedule in the internal memory. The standard schedule can be, for example, 40 minutes each day, or 10 days in total.

  As an adjustment method for lengthening the schedule, for example, (1) 40 minutes of training time on each day is lengthened to, for example, 50 minutes, 60 minutes, etc., and the number of sequences per day is increased. The training time is not changed for 40 minutes, and the number of trainings per day may be two in the morning and the afternoon to increase the number of trainings per day, and (3) to extend the number of training days.

  On the other hand, when it is determined in step S11 that the patient ID is registered, that is, when it is determined that the second day of rehabilitation or later, the control device 50 proceeds to step S15. Then, in step S15, the training control unit 53 reads a schedule stored in association with the patient ID from the patient ID from the memory, and the training control unit 53 controls the presentation device 20 for training according to the schedule.

The rehabilitation system 1 exerts the following actions and effects.
(1) The difference between the rehabilitation system 1 and the conventional rehabilitation system shown in FIG. 7 will be described. The present rehabilitation system 1 includes a frequency analysis unit 55 and a schedule determination unit 54, and the conventional rehabilitation system shown in FIG. 7 is different in that the frequency analysis unit 55 and the schedule determination unit 54 are not provided.

  The training control unit 53 of the conventional rehabilitation system 1 shown in FIG. 7 only carries out training for the number of times set in advance, regardless of the degree of disability of the patient and the state of plasticity. For this reason, the training amount suitable for the patient was not set.

  The control device 50 includes a frequency analysis unit 55 and a schedule determination unit 54. The controller 50 measures the electroencephalogram of the patient and creates a rehabilitation schedule based on the measured electroencephalogram. That is, it is possible to create a schedule that makes the patient's prognosis better before the start of rehabilitation. Therefore, rehabilitation can be performed according to the patient. For this reason, since the training schedule can be determined according to the degree of plasticity of the patient, the rehabilitation system 1 capable of more effective training can be provided.

  (2) The control device 50 creates a schedule according to the activity intensity of the α band of the brain waves. The activity intensity of the alpha band correlates well with the patient's prognosis. This can contribute to making the patient's prognosis better.

  (3) The controller 50 creates a schedule so that the rehabilitation period is longer when the alpha band activity intensity is low than when the alpha band activity intensity is high. That is, since the rehabilitation can be performed for a long time at the initial stage of rehabilitation where plasticity is considered to be particularly high, it is possible to improve the prognosis of the patient to patients estimated to be less effective by rehabilitation based on the activity intensity of the alpha band it can.

  (4) The control device 50 creates a schedule over multiple days before the start of rehabilitation on the first day. For this reason, rehabilitation can be performed on a schedule according to the patient from the beginning of the start including the first day of rehabilitation. This can contribute to making the patient's prognosis better.

  The specific form which this rehabilitation system 1 can take is not limited to the form illustrated by the said embodiment. The present rehabilitation system 1 can take various forms different from the above embodiment. The modification of the above-mentioned embodiment shown below is an example of the various forms which this rehabilitation system 1 can take.

  The control device 50 can also change the schedule thereafter if it is determined that the plasticity is low due to the activity intensity of the α wave of the electroencephalogram before the start of the training even after the second day. For example, if the activity intensity of the α wave is low after the second day, the schedule may be changed to increase the training time of one day. According to this configuration, the amount of training can be flexibly set in accordance with the daily activity intensity.

  ・ When the activity intensity of the alpha band is high, create a schedule so that at least one of the time for rehabilitation and the number of days for rehabilitation is shorter than the time when the intensity of the alpha band is low than the reference schedule. It can also be done.

  -A schedule can also be created so that at least one of the time for rehabilitation and the number of days for rehabilitation can be longer as the activity intensity in the alpha band is lower. In this case, instead of the reference schedule, a relationship map between the activity intensity of the α band and the time and number of days of rehabilitation may be stored in advance in the memory.

  The control device 50 can also create a schedule for single-day rehabilitation. In this case, it is possible to create the schedule of the day's rehabilitation based on the electroencephalogram before the start of the rehabilitation each day in the rehabilitation period defined by the occupational therapist or the like.

The frequency band of analysis is not limited to α waves, and the intensity can be used to create a schedule using the strength of all frequency bands.
The muscle stimulation control unit 59 and the muscle stimulation electrode 33, or the motor control unit 58 and the motor 32 may be omitted in order to make the system simple.

  -It can also be changed to the electric appliance 30 shaped to be attached to the patient's lower limbs.

  DESCRIPTION OF SYMBOLS 1 ... Rehabilitation system, 10 ... Electroencephalogram measuring apparatus, 20 ... Presentation apparatus, 30 ... Electric brace, 40 ... Operation part, 50 ... Control apparatus.

Claims (7)

An electroencephalogram measurement device for measuring the electroencephalogram of a patient;
A presentation device for presenting information and feedback to a patient;
Electrically powered equipment worn on the patient's body to provide electrical or mechanical stimulation;
A rehabilitation comprising a control device for extracting a signal related to exercise intention from the electroencephalogram measured by the electroencephalogram measurement device, and providing feedback from the presentation device and the electric brace when it is determined that the exercise intention is correctly represented A system,
The said control apparatus determines the training amount so that training according to the degree of plasticity may be implemented from the analysis result of the electroencephalogram before training. The rehabilitation system according to claim 1, wherein the electroencephalogram analysis in the control device analyzes an activity intensity of an α band. An electroencephalogram measurement device for measuring the electroencephalogram of a patient;
A presentation device for presenting information and feedback to a patient;
Electrically powered equipment worn on the patient's body to provide electrical or mechanical stimulation;
A rehabilitation comprising a control device for extracting a signal related to exercise intention from the electroencephalogram measured by the electroencephalogram measurement device, and providing feedback from the presentation device and the electric brace when it is determined that the exercise intention is correctly represented A system,
The controller determines the amount of training from the analysis result of the electroencephalogram before training ,
The electroencephalogram analysis in the said control apparatus is a rehabilitation system which analyzes the activity intensity of alpha belt . In the control device, a schedule is created so that the training time is longer when the activity intensity of the α band is low than when the activity intensity of the α band is high.
The rehabilitation system according to claim 2 or 3 . The controller increases training time per day when the activity intensity of the alpha band is lower than a threshold.
The rehabilitation system according to claim 4 . The control device performs electroencephalogram measurement before daily training and determines the training amount on the day
The rehabilitation system according to any one of claims 1 to 5 . The control device executes a process of analyzing the pre-training electroencephalogram measured by the electroencephalogram measurement device;
The control device executes a process of determining a training amount so that training according to the degree of plasticity is performed from the analysis result of the electroencephalogram before the training;
In the training based on the determined training amount, a process of outputting a signal for controlling a presentation device that presents information, and a process of wearing at least one of an electrical stimulation and a mechanical stimulation by being attached to the patient's body A control method of a rehabilitation system, including the step of: at least one of processing for outputting a signal for controlling a motorized appliance;