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Rikhof CJH, Leerskov KS, Prange-Lasonder GB, Prinsen EC, Spaich EG, Dosen S, Struijk LNSA, Buurke JH, Rietman JS. Combining robotics and functional electrical stimulation for assist-as-needed support of leg movements in stroke patients: A feasibility study. Med Eng Phys 2024; 130:104216. [PMID: 39160022 DOI: 10.1016/j.medengphy.2024.104216] [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: 03/12/2024] [Revised: 06/05/2024] [Accepted: 07/31/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Rehabilitation technology can be used to provide intensive training in the early phases after stroke. The current study aims to assess the feasibility of combining robotics and functional electrical stimulation (FES), with an assist-as-needed approach to support actively-initiated leg movements in (sub-)acute stroke patients. METHOD Nine subacute stroke patients performed repetitions of ankle dorsiflexion and/or knee extension movements, with and without assistance. The assist-as-needed algorithm determined the amount and type of support needed per repetition. The number of repetitions and range of motion with and without assistance were compared with descriptive statistics. Fatigue scores were obtained using the visual analogue scale (score 0-10). RESULTS Support was required in 44 % of the repetitions for ankle dorsiflexion and in 5 % of the repetitions of knee extension, The median fatigue score was 2.0 (IQR: 0.2) and 4.0 (IQR: 1.5) for knee and ankle, respectively, indicating mild to moderate perceived fatigue. CONCLUSION This study demonstrated the feasibility of assist-as-needed assistance through combined robotic and FES support of leg movements in stroke patients. It proved particularly useful for ankle dorsiflexion. Future research should focus on implementing this approach in a clinical setting, to assess clinical applicability and potential effects on leg function.
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Affiliation(s)
- Cindy J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands.
| | - Kasper S Leerskov
- Aalborg University, The neurorehabilitation Robotics and Engineering group, Center for Rehabilitation in Robotics, Department of Health Science and Technology, Gistrup 9260, Denmark
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands
| | - Erik C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands
| | - Erika G Spaich
- Aalborg University, Neurorehabilitation Systems group, Department of Health Science and Technology 9260, Aalborg Gistrup, Denmark
| | - Strahinja Dosen
- Aalborg University, Neurorehabilitation Systems group, Department of Health Science and Technology 9260, Aalborg Gistrup, Denmark
| | - Lotte N S Andreasen Struijk
- Aalborg University, The neurorehabilitation Robotics and Engineering group, Center for Rehabilitation in Robotics, Department of Health Science and Technology, Gistrup 9260, Denmark
| | - Jaap H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, Drienerlolaan 5 7522NB, Enschede, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands
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2
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Rikhof CJH, Feenstra Y, Fleuren JFM, Buurke JH, Prinsen EC, Rietman JS, Prange-Lasonder GB. Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review. J Neural Eng 2024; 21:021001. [PMID: 38527367 DOI: 10.1088/1741-2552/ad377c] [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: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 03/27/2024]
Abstract
Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients.Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles.Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment.Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.
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Affiliation(s)
- C J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Y Feenstra
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J F M Fleuren
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomedical Signals and systems, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - E C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - J S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - G B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
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Burchielli D, Lotti N, Missiroli F, Bokranz C, Pedrocchi A, Ambrosini E, Masia L. Adaptive Hybrid FES-Force Controller for Arm Exosuit. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176151 DOI: 10.1109/icorr55369.2022.9896493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Patients suffering from neuromuscular diseases experience motor disabilities which hinder their independence during activities of daily living (ADLs). For such impaired subjects, robotic devices and Functional Electrical Stimulation (FES) are technologies commonly used to rehabilitate lost functions. Nevertheless, both systems present some limitations, and merging FES and robots in Hybrid Robotic Rehabilitation Systems allows to overcome these boundaries. Here we propose for the first time a hybrid cooperative controller involving FES and a soft wearable upper arm exosuit to rehabilitate elbow movements. We tested the designed hybrid controller on six healthy participants. The results showed how the proposed hybrid controller allowed the wearers to perform flexion movements with no significant decrease in accuracy and precision with respect to the exosuit alone, while significantly decreasing the fatigue level by about 63% and delaying its onset with respect to the FES action alone.
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Sierotowicz M, Lotti N, Rupp R, Masia L, Castellini C. A Comprehensive Framework for the Modelling of Cartesian Force Output in Human Limbs. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176096 DOI: 10.1109/icorr55369.2022.9896547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neuromuscular functional electrical stimulation represents a valid technique for functional rehabilitation or, in the form of a neuroprosthesis, for the assistance of neurological patients. However, the selected stimulation of single muscles through surface electrodes remains challenging particularly for the upper extremity. In this paper, we present the MyoCeption, a comprehensive setup, which enables intuitive modeling of the user's musculoskeletal system, as well as proportional stimulation of the muscles with 16-bit resolution through up to 10 channels. The system can be used to provide open-loop force control, which, if coupled with an adequate body tracking system, can be used to implement an impedance control where the control loop is closed around the body posture. The system is completely self-contained and can be used in a wide array of scenarios, from rehabilitation to VR to teleoperation. Here, the MyoCeption's control environment has been experimentally validated through comparison with a third-party simulation suite. The results indicate that the musculoskeletal model used for the MyoCeption provides muscle geometries that are qualitatively similar to those computed in the baseline model.
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Makowski NS, Fitzpatrick MN, Triolo RJ, Reyes RD, Quinn RD, Audu M. Biologically Inspired Optimal Terminal Iterative Learning Control for the Swing Phase of Gait in a Hybrid Neuroprosthesis: A Modeling Study. Bioengineering (Basel) 2022; 9:71. [PMID: 35200424 PMCID: PMC8869465 DOI: 10.3390/bioengineering9020071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: An iterative learning control (ILC) strategy was developed for a "Muscle First" Motor-Assisted Hybrid Neuroprosthesis (MAHNP). The MAHNP combines a backdrivable exoskeletal brace with neural stimulation technology to enable persons with paraplegia due to spinal cord injury (SCI) to execute ambulatory motions and walk upright. (2) Methods: The ILC strategy was developed to swing the legs in a biologically inspired ballistic fashion. It maximizes muscular recruitment and activates the motorized exoskeletal bracing to assist the motion as needed. The control algorithm was tested using an anatomically realistic three-dimensional musculoskeletal model of the lower leg and pelvis suitably modified to account for exoskeletal inertia. The model was developed and tested with the OpenSim biomechanical modeling suite. (3) Results: Preliminary data demonstrate the efficacy of the controller in swing-leg simulations and its ability to learn to balance muscular and motor contributions to improve performance and accomplish consistent stepping. In particular, the controller took 15 iterations to achieve the desired outcome with 0.3% error.
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Affiliation(s)
- Nathaniel S. Makowski
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, OH 44109, USA
- APT Center, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA; (R.J.T.); (M.A.)
| | - Marshaun N. Fitzpatrick
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (M.N.F.); (R.D.Q.)
| | - Ronald J. Triolo
- APT Center, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA; (R.J.T.); (M.A.)
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Ryan-David Reyes
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Roger D. Quinn
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (M.N.F.); (R.D.Q.)
| | - Musa Audu
- APT Center, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA; (R.J.T.); (M.A.)
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
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Bardi E, Dalla Gasperina S, Pedrocchi A, Ambrosini E. Adaptive Cooperative Control for Hybrid FES-Robotic Upper Limb Devices: a Simulation Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6398-6401. [PMID: 34892576 DOI: 10.1109/embc46164.2021.9630331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Robotic systems and Functional Electrical Stimulation (FES) are common technologies exploited in motor rehabilitation. However, they present some limits. To overcome the weaknesses of both approaches, hybrid cooperative devices have been developed, which combine the action of the robot and that of the electrically stimulated muscles on the same joint. In this work, we present a novel adaptive cooperative controller for the rehabilitation of the upper limb. The controller comprises an allocator - which breaks down the reference torque between the motor and the FES a-priori contributions based on muscle fatigue estimation - an FES closed-loop controller, and an impedance control loop on the motor to correct trajectory tracking errors. The controller was tested in simulation environment reproducing elbow flexion/extension movements. Results showed that the controller could reduce motor torque requirements with respect to the motor-only case, at the expense of trajectory tracking performance. Moreover, it could improve fatigue management with respect to the FES-only case. In conclusion, the proposed control strategy provides a good trade-off between motor torque consumption and trajectory tracking performance, while the allocator manages fatigue-related phenomena.Clinical relevance-The use of allocation proves to be effective in both reducing motor torque and FES-induced muscle fatigue and might be an effective solution for hybrid FES-robotic systems.
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Abstract
For individuals with movement impairments due to neurological injuries, rehabilitative therapies such as functional electrical stimulation (FES) and rehabilitation robots hold vast potential to improve their mobility and activities of daily living. Combining FES with rehabilitation robots results in intimately coordinated human–robot interaction. An example of such interaction is FES cycling, where motorized assistance can provide high-intensity and repetitive practice of coordinated limb motion, resulting in physiological and functional benefits. In this paper, the development of multiple FES cycling testbeds and safeguards is described, along with the switched nonlinear dynamics of the cycle–rider system. Closed-loop FES cycling control designs are described for cadence and torque tracking. For each tracking objective, the authors’ past work on robust and adaptive controllers used to compute muscle stimulation and motor current inputs is presented and discussed. Experimental results involving both able-bodied individuals and participants with neurological injuries are provided for each combination of controller and tracking objective. Trade-offs for the control algorithms are discussed based on the requirements for implementation, desired rehabilitation outcomes and resulting rider performance. Lastly, future works and the applicability of the developed methods to additional technologies including teleoperated robotics are outlined.
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8
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Reyes RD, Kobetic R, Nandor M, Makowski N, Audu M, Quinn R, Triolo R. Effect of Joint Friction Compensation on a "Muscle-First" Motor-Assisted Hybrid Neuroprosthesis. Front Neurorobot 2020; 14:588950. [PMID: 33362502 PMCID: PMC7759638 DOI: 10.3389/fnbot.2020.588950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
This study assessed the metabolic energy consumption of walking with the external components of a “Muscle-First” Motor Assisted Hybrid Neuroprosthesis (MAHNP), which combines implanted neuromuscular stimulation with a motorized exoskeleton. The “Muscle-First” approach prioritizes generating motion with the wearer's own muscles via electrical stimulation with the actuators assisting on an as-needed basis. The motorized exoskeleton contributes passive resistance torques at both the hip and knee joints of 6Nm and constrains motions to the sagittal plane. For the muscle contractions elicited by neural stimulation to be most effective, the motorized joints need to move freely when not actively assisting the desired motion. This study isolated the effect of the passive resistance or “friction” added at the joints by the assistive motors and transmissions on the metabolic energy consumption of walking in the device. Oxygen consumption was measured on six able-bodied subjects performing 6 min walk tests at three different speeds (0.4, 0.8, and 1.2 m/s) under two different conditions: one with the motors producing no torque to compensate for friction, and the other having the motors injecting power to overcome passive friction based on a feedforward friction model. Average oxygen consumption in the uncompensated condition across all speeds, measured in Metabolic Equivalent of Task (METs), was statistically different than the friction compensated condition. There was an average decrease of 8.8% for METs and 1.9% for heart rate across all speeds. While oxygen consumption was reduced when the brace performed friction compensation, other factors may have a greater contribution to the metabolic energy consumption when using the device. Future studies will assess the effects of gravity compensation on the muscular effort required to lift the weight of the distal segments of the exoskeleton as well as the sagittal plane constraint on walking motions in individuals with spinal cord injuries (SCI).
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Affiliation(s)
- Ryan-David Reyes
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Rudolf Kobetic
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Mark Nandor
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Nathaniel Makowski
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Physical Medicine & Rehabilitation, MetroHealth Medical Center, Cleveland, OH, United States
| | - Musa Audu
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Roger Quinn
- Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Ronald Triolo
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
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Perez-Ibarra JC, Siqueira AAG, Krebs HI. Identification of Gait Events in Healthy Subjects and With Parkinson's Disease Using Inertial Sensors: An Adaptive Unsupervised Learning Approach. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2933-2943. [PMID: 33237863 DOI: 10.1109/tnsre.2020.3039999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Automatic identification of gait events is an essential component of the control scheme of assistive robotic devices. Many available techniques suffer limitations for real-time implementations and in guaranteeing high performances when identifying events in subjects with gait impairments. Machine learning algorithms offer a solution by enabling the training of different models to represent the gait patterns of different subjects. Here our aim is twofold: to remove the need for training stages using unsupervised learning, and to modify the parameters according to the changes within a walking trial using adaptive procedures. We developed two adaptive unsupervised algorithms for real-time detection of four gait events, using only signals from two single-IMU foot-mounted wearable devices. We evaluated the algorithms using data collected from five healthy adults and seven subjects with Parkinson's disease (PD) walking overground and on a treadmill. Both algorithms obtained high performance in terms of accuracy ( F1 -score ≥ 0.95 for both groups), and timing agreement using a force-sensitive resistors as reference (mean absolute differences of 66 ± 53 msec for the healthy group, and 58 ± 63 msec for the PD group). The proposed algorithms demonstrated the potential to learn optimal parameters for a particular participant and for detecting gait events without additional sensors, external labeling, or long training stages.
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Schicketmueller A, Rose G, Hofmann M. Feasibility of a Sensor-Based Gait Event Detection Algorithm for Triggering Functional Electrical Stimulation during Robot-Assisted Gait Training. SENSORS 2019; 19:s19214804. [PMID: 31694188 PMCID: PMC6864796 DOI: 10.3390/s19214804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
Technologies such as robot-assisted gait trainers or functional electrical stimulation can improve the rehabilitation process of people affected with gait disorders due to stroke or other neurological defects. By combining both technologies, the potential disadvantages of each technology could be compensated and simultaneously, therapy effects could be improved. Thus, an algorithm was designed that aims to detect the gait cycle of a robot-assisted gait trainer. Based on movement data recorded with inertial measurement units, gait events can be detected. These events can further be used to trigger functional electrical stimulation. This novel setup offers the possibility of equipping a broad range of potential robot-assisted gait trainers with functional electrical stimulation. The aim of this paper in particular was to test the feasibility of a system using inertial measurement units for gait event detection during robot-assisted gait training. Thus, a 39-year-old healthy male adult executed a total of six training sessions with two robot-assisted gait trainers (Lokomat and Lyra). The measured data from the sensors were analyzed by a custom-made gait event detection algorithm. An overall detection rate of 98.1% ± 5.2% for the Lokomat and 94.1% ± 6.8% for the Lyra was achieved. The mean type-1 error was 0.3% ± 1.2% for the Lokomat and 1.9% ± 4.3% for the Lyra. As a result, the setup provides promising results for further research and a technique that can enhance robot-assisted gait trainers by adding functional electrical stimulation to the rehabilitation process.
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Affiliation(s)
- Andreas Schicketmueller
- HASOMED GmbH, Paul-Ecke-Str. 1, Magdeburg 39114, Germany;
- Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg Universitaetsplatz 2, Magdeburg 39106, Germany;
- Correspondence: ; Tel.: +49-391-6230112
| | - Georg Rose
- Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg Universitaetsplatz 2, Magdeburg 39106, Germany;
| | - Marc Hofmann
- HASOMED GmbH, Paul-Ecke-Str. 1, Magdeburg 39114, Germany;
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Bao X, Mao ZH, Munro P, Sun Z, Sharma N. Sub-optimally Solving Actuator Redundancy in a Hybrid Neuroprosthetic System with a Multi-layer Neural Network Structure. INTERNATIONAL JOURNAL OF INTELLIGENT ROBOTICS AND APPLICATIONS 2019; 3:298-313. [PMID: 33283042 DOI: 10.1007/s41315-019-00100-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Functional electrical stimulation (FES) has recently been proposed as a supplementary torque assist in lower-limb powered exoskeletons for persons with paraplegia. In the combined system, also known as a hybrid neuroprosthesis, both FES-assist and the exoskeleton act to generate lower-limb torques to achieve standing and walking functions. Due to this actuator redundancy, we are motivated to optimally allocate FES-assist and exoskeleton torque based on a performance index that penalizes FES overuse to minimize muscle fatigue while also minimizing regulation or tracking errors. Traditional optimal control approaches need a system model to optimize; however, it is often difficult to formulate a musculoskeletal model that accurately predicts muscle responses due to FES. In this paper, we use a novel identification and control structure that contains a recurrent neural network (RNN) and several feedforward neural networks (FNNs). The RNN is trained by supervised learning to identify the system dynamics, while the FNNs are trained by a reinforcement learning method to provide sub-optimal control actions. The output layer of each FNN has its unique activation functions, so that the asymmetric constraint of FES and the symmetric constraint of exoskeleton motor control input can be realized. This new structure is experimentally validated on a seated human participant using a single joint hybrid neuroprosthesis.
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Affiliation(s)
- Xuefeng Bao
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA,USA 15261
| | - Zhi-Hong Mao
- Department of Electrical and Computer Engineering and the Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA,USA 15261
| | - Paul Munro
- Department of Electrical and Computer Engineering and the Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA,USA 15261
| | - Ziyue Sun
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA,USA 15261
| | - Nitin Sharma
- Department of Mechanical Engineering and Materials Science and the Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA,USA 15261
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Romero-Sánchez F, Bermejo-García J, Barrios-Muriel J, Alonso FJ. Design of the Cooperative Actuation in Hybrid Orthoses: A Theoretical Approach Based on Muscle Models. Front Neurorobot 2019; 13:58. [PMID: 31417390 PMCID: PMC6684761 DOI: 10.3389/fnbot.2019.00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022] Open
Abstract
Hybrid orthoses or rehabilitation exoskeletons have proven to be a powerful tool for subjects with gait disabilities due to their combined use of electromechanical actuation to provide motion and support, and functional electrical stimulation (FES) to contract muscle tissue so as to improve the rehabilitation process. In these devices, each degree of freedom is governed by two actuators. The main issue arises in the design of the two actuation profiles for there to be natural or normative gait motion in which the two actuators are transparent to each other. Hybrid exoskeleton control solutions proposed in the literature have been based on tracking the desired kinematics and applying FES to maintain the desired motion rather than to attain the values expected for physiological movement. This work proposes a muscle-model approach involving inverse dynamics optimization for the design of combined actuation in hybrid orthoses. The FES profile calculated in this way has the neurophysiological meaningfulness for the device to be able to fulfill its rehabilitative purpose. A general scheme is proposed for a hybrid hip-knee-ankle-foot orthosis. The actuation profiles, when muscle tissue is fatigued due to FES actuation are analyzed, and an integrated approach is presented for estimating the actuation profiles so as to overcome muscle peak force reduction during stimulation. The objective is to provide a stimulation profile for each muscle individually that is compatible with the desired kinematics and actuation of the orthosis. The hope is that the results may contribute to the design of subject-specific rehabilitation routines with hybrid exoskeletons, improving the exoskeleton's actuation while maintaining its rehabilitative function.
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Affiliation(s)
- Francisco Romero-Sánchez
- Department of Mechanical Engineering, Energy and Materials, University of Extremadura, Badajoz, Spain
| | - Javier Bermejo-García
- Department of Mechanical Engineering, Energy and Materials, University of Extremadura, Badajoz, Spain
| | - Jorge Barrios-Muriel
- Department of Mechanical Engineering, Energy and Materials, University of Extremadura, Badajoz, Spain
| | - Francisco J Alonso
- Department of Mechanical Engineering, Energy and Materials, University of Extremadura, Badajoz, Spain
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Cousin CA, Rouse CA, Duenas VH, Dixon WE. Controlling the Cadence and Admittance of a Functional Electrical Stimulation Cycle. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1181-1192. [PMID: 31059451 DOI: 10.1109/tnsre.2019.2914579] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For an individual suffering from a neurological condition, such as spinal cord injury, traumatic brain injury, or stroke, motorized functional electrical stimulation (FES) cycling is a rehabilitation strategy, which offers numerous health benefits. Motorized FES cycling is an example of physical human-robot interaction in which both systems must be controlled; the human is actuated by applying neuromuscular electrical stimulation to the large leg muscle groups, and the cycle is actuated through its onboard electric motor. While the rider is stimulated using a robust sliding-mode controller, the cycle utilizes an admittance controller to preserve rider safety. The admittance controller is shown to be passive with respect to the rider, and the cadence controller is shown to be globally exponentially stable through a Lyapunov-like switched systems stability analysis. Experiments are conducted on three able-bodied participants and four participants with neurological conditions (NCs) to demonstrate the efficacy of the developed controller and investigate the effect of manipulating individual admittance parameters. Results demonstrate an average admittance cadence error of -0.06±1.47 RPM for able-bodied participants and -0.02 ± 0.93 RPM for participants with NCs.
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Alonso V, de la Puente P. System Transparency in Shared Autonomy: A Mini Review. Front Neurorobot 2018; 12:83. [PMID: 30555317 PMCID: PMC6284032 DOI: 10.3389/fnbot.2018.00083] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022] Open
Abstract
What does transparency mean in a shared autonomy framework? Different ways of understanding system transparency in human-robot interaction can be found in the state of the art. In one of the most common interpretations of the term, transparency is the observability and predictability of the system behavior, the understanding of what the system is doing, why, and what it will do next. Since the main methods to improve this kind of transparency are based on interface design and training, transparency is usually considered a property of such interfaces, while natural language explanations are a popular way to achieve transparent interfaces. Mechanical transparency is the robot capacity to follow human movements without human-perceptible resistive forces. Transparency improves system performance, helping reduce human errors, and builds trust in the system. One of the principles of user-centered design is to keep the user aware of the state of the system: a transparent design is a user-centered design. This article presents a review of the definitions and methods to improve transparency for applications with different interaction requirements and autonomy degrees, in order to clarify the role of transparency in shared autonomy, as well as to identify research gaps and potential future developments.
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Affiliation(s)
- Victoria Alonso
- ETSI Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Madrid, Spain
| | - Paloma de la Puente
- ETSI Industriales, Universidad Politécnica de Madrid, Madrid, Spain
- Centre for Automation and Robotics, Universidad Politécnica de Madrid-CSIC, Madrid, Spain
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Gad* A. Functional Electrical Stimulation (FES): Clinical successes and failures to date. ACTA ACUST UNITED AC 2018. [DOI: 10.29328/journal.jnpr.1001022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ekelem A, Goldfarb M. Supplemental Stimulation Improves Swing Phase Kinematics During Exoskeleton Assisted Gait of SCI Subjects With Severe Muscle Spasticity. Front Neurosci 2018; 12:374. [PMID: 29910710 PMCID: PMC5992413 DOI: 10.3389/fnins.2018.00374] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
Spasticity is a common comorbidity associated with spinal cord injury (SCI). Robotic exoskeletons have recently emerged to facilitate legged mobility in people with motor complete SCI. Involuntary muscle activity attributed to spasticity, however, can prevent such individuals from using an exoskeleton. Specifically, although most exoskeleton technologies can accommodate low to moderate spasticity, the presence of moderate to severe spasticity can significantly impair gait kinematics when using an exoskeleton. In an effort to potentially enable individuals with moderate to severe spasticity to use exoskeletons more effectively, this study investigates the use of common peroneal stimulation in conjunction with exoskeleton gait assistance. The electrical stimulation is timed with the exoskeleton swing phase, and is intended to acutely suppress extensor spasticity through recruitment of the flexion withdrawal reflex (i.e., while the stimulation is activated) to enable improved exoskeletal walking. In order to examine the potential efficacy of this approach, two SCI subjects with severe extensor spasticity (i.e., modified Ashworth ratings of three to four) walked in an exoskeleton with and without supplemental stimulation while knee and hip motion was measured during swing phase. Stimulation was alternated on and off every ten steps to eliminate transient therapeutic effects, enabling the acute effects of stimulation to be isolated. These experiments indicated that common peroneal stimulation on average increased peak hip flexion during the swing phase of walking by 21.1° (236%) and peak knee flexion by 14.4° (56%). Additionally, use of the stimulation decreased the swing phase RMS motor current by 228 mA (15%) at the hip motors and 734 mA (38%) at the knee motors, indicating improved kinematics were achieved with reduced effort from the exoskeleton. Walking with the exoskeleton did not have a significant effect on modified Ashworth scores, indicating the common peroneal stimulation has only acute effects on suppressing extensor tone and aiding flexion. This preliminary data indicates that such supplemental stimulation may be used to improve the quality of movement provided by exoskeletons for persons with severe extensor spasticity in the lower limb.
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Affiliation(s)
- Andrew Ekelem
- Department of Mechanical Engineering, Center for Rehabilitation Engineering and Assistive Technology, Vanderbilt University, Nashville, TN, United States
| | - Michael Goldfarb
- Department of Mechanical Engineering, Center for Rehabilitation Engineering and Assistive Technology, Vanderbilt University, Nashville, TN, United States
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