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Lim D, Pei W, Lee JW, Musselman KE, Masani K. Feasibility of using a depth camera or pressure mat for visual feedback balance training with functional electrical stimulation. Biomed Eng Online 2024; 23:19. [PMID: 38347584 PMCID: PMC10863251 DOI: 10.1186/s12938-023-01191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Individuals with incomplete spinal-cord injury/disease are at an increased risk of falling due to their impaired ability to maintain balance. Our research group has developed a closed-loop visual-feedback balance training (VFBT) system coupled with functional electrical stimulation (FES) for rehabilitation of standing balance (FES + VFBT system); however, clinical usage of this system is limited by the use of force plates, which are expensive and not easily accessible. This study aimed to investigate the feasibility of a more affordable and accessible sensor such as a depth camera or pressure mat in place of the force plate. Ten able-bodied participants (7 males, 3 females) performed three sets of four different standing balance exercises using the FES + VFBT system with the force plate. A depth camera and pressure mat collected centre of mass and centre of pressure data passively, respectively. The depth camera showed higher Pearson's correlation (r > 98) and lower root mean squared error (RMSE < 10 mm) than the pressure mat (r > 0.82; RMSE < 4.5 mm) when compared with the force plate overall. Stimulation based on the depth camera showed lower RMSE than that based on the pressure mat relative to the FES + VFBT system. The depth camera shows potential as a replacement sensor to the force plate for providing feedback to the FES + VFBT system.
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Affiliation(s)
- Derrick Lim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - William Pei
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Megía-García Á, Serrano-Muñoz D, Comino-Suárez N, Del-Ama AJ, Moreno JC, Gil-Agudo A, Taylor J, Gómez-Soriano J. Effect of posture and body weight loading on spinal posterior root reflex responses. Eur J Neurosci 2021; 54:6575-6586. [PMID: 34494329 DOI: 10.1111/ejn.15448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Abstract
The posterior root muscle response (PRM) is a monosynaptic reflex that is evoked by single pulse transcutaneous spinal cord stimulation (tSCS). The main aim of this work was to analyse how body weight loading influences PRM reflex threshold measured from several lower limb muscles in healthy participants. PRM reflex responses were evoked with 1-ms rectangular monophasic pulses applied at an interval of 6 s via a self-adhesive electrode (9 × 5 cm) at the T11-T12 vertebral level. Surface electromyographic activity of lower limb muscles was recorded during four different conditions, one in decubitus supine (DS) and the other three involving standing at 100%, 50%, and 0% body weight loading (BW). PRM threshold intensity, peak-to-peak amplitude, and latency for each muscle were analysed in different conditions study. PRM reflex threshold increased with body weight unloading compared with DS, and the largest change was observed between DS and 0% BW for the proximal muscles and between DS and 50% BW for distal muscles. Peak-to-peak amplitude analysis showed only a significant mean decrease of 34.6% (SD 10.4, p = 0.028) in TA and 53.6% (SD 15.1, p = 0.019) in GM muscles between DS and 50% BW. No significant differences were observed for PRM latency. This study has shown that sensorimotor networks can be activated with tSCS in various conditions of body weight unloading. Higher stimulus intensities are necessary to evoke reflex response during standing at 50% body weight loading. These results have practical implications for gait rehabilitation training programmes that include body weight support.
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Affiliation(s)
- Álvaro Megía-García
- Biomechanical and Technical Aids Unit, National Hospital for Paraplegia, SESCAM, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - Diego Serrano-Muñoz
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - Natalia Comino-Suárez
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Antonio J Del-Ama
- Biomechanical and Technical Aids Unit, National Hospital for Paraplegia, SESCAM, Toledo, Spain.,Rey Juan Carlos University, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Angel Gil-Agudo
- Biomechanical and Technical Aids Unit, National Hospital for Paraplegia, SESCAM, Toledo, Spain
| | - Julian Taylor
- Sensorimotor Function Group, National Hospital for Paraplegia, SESCAM, Toledo, Spain.,Harris Manchester College, University of Oxford, Oxford, UK
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
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Bao X, Molazadeh V, Dodson A, Dicianno BE, Sharma N. Using Person-Specific Muscle Fatigue Characteristics to Optimally Allocate Control in a Hybrid Exoskeleton - Preliminary Results. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2020; 2:226-235. [PMID: 32661511 PMCID: PMC7357894 DOI: 10.1109/tmrb.2020.2977416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Currently controllers that dynamically modulate functional electrical stimulation (FES) and a powered exoskeleton at the same time during standing-up movements are largely unavailable. In this paper, an optimal shared control of FES and a powered exoskeleton is designed to perform sitting to standing (STS) movements with a hybrid exoskeleton. A hierarchical control design is proposed to overcome the difficulties associated with developing an optimal real-time solution for the highly nonlinear and uncertain STS control model with multiple degrees of freedom. A higher-level robust nonlinear control design is derived to exponentially track a time-invariant desired STS movement profile. Then, a lower-level optimal control allocator is designed to distribute control between FES and the knee electric motors. The allocator uses a person's muscle fatigue and recovery dynamics to determine an optimal ratio between the FES-elicited knee torque and the exoskeleton assist. Experiments were performed on human participants, two persons without disability and one person with spinal cord injury (SCI), to validate the feedback controller and the optimal torque allocator. The muscles of the participant with SCI did not actively contract to FES, so he was only tested with the powered exoskeleton controller. The experimental results show that the proposed hierarchical control design is a promising method to effect shared control in a hybrid exoskeleton.
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Affiliation(s)
- Xuefeng Bao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Vahidreza Molazadeh
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Dodson
- Joint Department of Biomedical Engineering at North Carolina State University Raleigh NC and University of North Carolina at Chapel-Hill, NC USA
| | - Brad E. Dicianno
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
- Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, PA, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Nitin Sharma
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
- Joint Department of Biomedical Engineering at North Carolina State University Raleigh NC and University of North Carolina at Chapel-Hill, NC USA
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Delianides C, Tyler D, Pinault G, Ansari R, Triolo R. Implanted High Density Cuff Electrodes Functionally Activate Human Tibial and Peroneal Motor Units Without Chronic Detriment to Peripheral Nerve Health. Neuromodulation 2020; 23:754-762. [PMID: 32189421 DOI: 10.1111/ner.13110] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Peripheral nerve stimulation via multi-contact nerve cuff electrodes (NCEs) has proved effective in restoring function to individuals with lower-extremity paralysis. This study investigates clinical measures of nerve health over one year post-implantation of a composite flat-interface nerve electrode (C-FINE) on the tibial and peroneal nerves above the knee in a human volunteer. This represents the first deployment of a novel NCE on new neural targets in a uniquely challenging location prone to prolonged externally applied forces, making acute and chronic postoperative observation critical. MATERIALS AND METHODS A 27-year-old man with an incomplete spinal cord injury (AIS C) at the C3 to C4 level received eight-contact C-FINEs bilaterally on the tibial and peroneal nerves, proximal to the knee. Access to four contacts per cuff exhibiting the most desirable responses was externalized via temporary percutaneous leads. Percutaneous leads were later removed, with contacts generating the best dorsiflexion (two of four) and plantar flexion (one of four) reconnected to a permanently implanted pulse generator. For 13 months post-implantation, nerve health and cuff performance were assessed through motor nerve conduction velocity (MNCV) studies, clinical needle electromyography, compound motor action potential (CMAP), sensory nerve action potential (SNAP), stimulation-evoked tetanic moment collection, and lower-limb circumference measurements. RESULTS Tibial and peroneal MNCVs remained stable bilaterally above 40 m/sec, with CMAPs increased or stable after six months. SNAPs remained stable across all measurements. CMAP initial charge thresholds remained below 50 nC, with minimal changes to muscle recruitment order in three of four externalized contacts per cuff. Peak tetanic moments remained stable, with bilateral increases in thigh and calf circumferences of 5% and 14% over one year. CONCLUSIONS Above-knee tibial and peroneal NCEs can restore stimulated ankle-joint function without chronic nerve health detriments. Alongside previous femoral nerve data, this study demonstrates the ability of NCEs to enhance lower-extremity function with limited neuromuscular impact.
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Affiliation(s)
- Christopher Delianides
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Dustin Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Rahila Ansari
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Ronald Triolo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
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